Paiva António, Ferreira José Bernardo, Serrano Simão
Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, PRT.
Physical Medicine and Rehabilitation, Centro Hospitalar de Leiria, Leiria, PRT.
Cureus. 2023 Nov 18;15(11):e48996. doi: 10.7759/cureus.48996. eCollection 2023 Nov.
Post-surgical neuropathic pain is still an underdiagnosed medical condition with persistent pain occurring in 10-50% of patients submitted to surgery. We present a case of a 52-year-old patient with persistent paracervical, supraclavicular, and upper chest neuropathic pain after the excision of a massive deep right cervical tumor, concluded to be an accessory spinal nerve schwannoma. A thorough physical and ultrasound examination helped conclude injury of the superficial cervical plexus. Therefore, an ultrasound-guided hydrodissection of several neuromas was performed at the level of the superficial cervical plexus. After three procedures, pain and quality of life scores improved, with a reduction of anxiety and depression symptoms. Due to the positive response, the patient was referred for a peripheral nerve stimulator implantation, allowing self-control of pain, in a home setting.
术后神经性疼痛仍然是一种诊断不足的病症，10%至50%接受手术的患者会出现持续性疼痛。我们报告一例52岁患者，在切除右侧深部巨大颈部肿瘤（诊断为副脊神经鞘瘤）后，出现持续性宫颈旁、锁骨上及上胸部神经性疼痛。全面的体格检查和超声检查有助于诊断颈浅丛损伤。因此，在颈浅丛水平对多个神经瘤进行了超声引导下水分离术。经过三次治疗，疼痛和生活质量评分有所改善，焦虑和抑郁症状减轻。由于反应良好，患者被转诊接受外周神经刺激器植入，以便在家中自行控制疼痛。
