Calava J M, Patt R B, Reddy S, Varma D G, Chiang J
Department of Anesthesiology and Critical Care, University of Texas/M. D. Anderson Cancer Center, Houston, USA.
Clin J Pain. 1996 Mar;12(1):69-75. doi: 10.1097/00002508-199603000-00013.
A 56-year-old man with widely metastatic liposarcoma, after left Tower extremity amputation, complained of severe right lower extremity pain. Trials of systemic opioids had resulted in poor pain control while introducing intolerable dose-limiting side effects.
Initial inpatient management consisted of a lumbar epidural infusion of a dilute local anesthetic and preservative-free morphine. This provided satisfactory relief but was discontinued because of recrudescence of phantom limb pain. A lumbar epidural infusion of preservative-free morphine sulfate was associated with poor pain relief, central nervous system (CNS) side effects, and severe urinary retention resulting in acute renal failure. A repeated trial of parental opioids provided marginal pain relief with persistent CNS side effects. Chemical neurolysis of the lumbar plexus was performed with 10 ml of 10% aqueous phenol injected into the psoas muscle sheath. The pain gradually resolved over a 2-day period without apparent side effects. Motor function was preserved, pain was resolved, and as systemic opioids were reduced, cognitive function and overall well-being were improved.
一名56岁广泛转移性脂肪肉瘤男性患者，在左下肢截肢后，主诉右下肢剧痛。全身性阿片类药物试验在控制疼痛方面效果不佳，同时出现了难以耐受的剂量限制性副作用。
最初的住院治疗包括在腰椎硬膜外输注稀释的局部麻醉药和不含防腐剂的吗啡。这提供了满意的缓解，但因幻肢痛复发而停药。腰椎硬膜外输注不含防腐剂的硫酸吗啡止痛效果不佳，出现中枢神经系统（CNS）副作用以及严重尿潴留导致急性肾衰竭。再次尝试使用胃肠外阿片类药物，止痛效果有限且持续存在中枢神经系统副作用。向腰大肌鞘内注射10毫升10%的苯酚水溶液对腰丛进行化学性神经溶解。疼痛在2天内逐渐缓解，未出现明显副作用。运动功能得以保留，疼痛得到缓解，随着全身性阿片类药物用量减少，认知功能和整体健康状况得到改善。
