腰交感神经阻滞治疗一名18个月大女童的复杂性区域疼痛综合征：突破障碍的病例报告及文献综述

Lumbar Sympathetic Block to Treat CRPS in an 18-Month-Old Girl: A Breaking Barriers Case Report and Review of Literature.

作者信息

Ayad Amany E, Agiza Nora A, Elrifay Amr H, Mortada Ahmed M, Girgis Marian Y, Varrassi Giustino

机构信息

Anesthesia, ICU and Pain Department, Cairo University, Cairo, Egypt.

Anesthesia, ICU and Pain Department, Cairo University, West Somid, Megawra11, Street 111, Villa 2, 6th of October City, Egypt.

出版信息

Pain Ther. 2024 Dec;13(6):1325-1334. doi: 10.1007/s40122-024-00650-1. Epub 2024 Sep 5.

DOI:10.1007/s40122-024-00650-1

PMID:39235698

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11544111/

Abstract

BACKGROUND

Children under the age of 3 years have been diagnosed with complex regional pain syndrome (CRPS). They were found to be functionally disadvantaged and psychologically distressed in relation to children with other painful conditions.

CASE PRESENTATION

An 18-month-old baby girl was referred to the pain clinic with a history of severe right lower limb pain that had begun 2 months earlier. The parents were unable to recall any trauma before the painful situation. Pain and allodynia were severe and extended from the toes to the gluteus area. She was low weight for her age (6700 g). The patient was on the maximum doses of gabapentin and amitriptyline accepted for her body weight and did not have the possibility to start rehabilitation due to severe pain and allodynia. After discussing the risks and potential benefits of a planned lumbar sympathetic block (LSB), the parents approved the interventional procedure. This is the first case report describing the LSB technique at such a young age.

METHOD

A lumbar sympathetic block was carried on at the third lumbar vertebral level, fluoroscopy-guided, and under general anesthesia (GA) initiated with ketamine iv. A 4-cm needle was introduced using a tunneled vision approach in an oblique view at the L3 level until adequate depth was confirmed in the lateral position. Safety considerations were taken in relation to the radiation dose and all drugs injected with dose adjustment to her body weight. The block was successful (the skin temperature increased by 2.8 °C) and was uneventful. Pain and allodynia were completely alleviated in the recovery room. At the follow-up after 3 and 8 weeks, the parents reported an 80% improvement in pain and allodynia, a 70% improvement in sleep, a weight gain of 900 g, and that she had started rehabilitation.

CONCLUSIONS

Lumbar sympathetic blocks can be considered at a very young age to treat CRPS if other non-invasive measures fail.

摘要

背景

3岁以下儿童已被诊断患有复杂性区域疼痛综合征（CRPS）。与患有其他疼痛病症的儿童相比，他们在功能上处于劣势且心理痛苦。

病例介绍

一名18个月大的女婴因严重右下肢疼痛病史2个月前开始被转诊至疼痛诊所。父母无法回忆起疼痛发作前的任何外伤史。疼痛和痛觉过敏严重，从脚趾延伸至臀区。她的体重低于同龄人（6700克）。患者已按其体重接受了最大剂量的加巴喷丁和阿米替林治疗，由于严重疼痛和痛觉过敏而无法开始康复治疗。在讨论了计划性腰交感神经阻滞（LSB）的风险和潜在益处后，父母批准了该介入手术。这是第一例描述在如此年幼时进行LSB技术的病例报告。

方法

在第三腰椎水平进行腰交感神经阻滞，在荧光透视引导下，静脉注射氯胺酮诱导全身麻醉（GA）。在L3水平以斜视图采用隧道视野法插入一根4厘米长的针，直到在侧卧位确认达到足够深度。考虑到辐射剂量以及所有注射药物均根据她的体重进行剂量调整等安全因素。阻滞成功（皮肤温度升高2.8°C）且过程顺利。在恢复室疼痛和痛觉过敏完全缓解。在3周和8周后的随访中，父母报告疼痛和痛觉过敏改善了80%，睡眠改善了70%，体重增加了900克，并且她已开始康复治疗。