Kaki A M, Lewis G W
Department of Anaesthesia, Ottawa Civic Hospital, University of Ottawa, Ontario, Canada.
Reg Anesth Pain Med. 1998 Mar-Apr;23(2):214-8. doi: 10.1097/00115550-199823020-00018.
We provided care for a 47-year-old female with a history of lung carcinoma and bony metastases who sustained a pathologic fracture of the right acetabulum causing severe and uncontrolled pain in the right groin. Her pain was rated as 8-10 on a 10-point visual analog scale (VAS). Her terminal disease and poor surgical risk precluded therapeutic operative intervention. Consequently, a neurolytic block of the lumbar plexus was performed as a palliative measure.
A modified inguinal paravascular (lumbar plexus) block technique was used. A 17-gauge Tuohy needle was inserted in the groin area just lateral to femoral artery and 1 cm below the inguinal ligament. A guide wire was threaded through the needle and subsequently an angiogram catheter was introduced over the wire into the psoas muscle. Radiographic confirmation of the position was obtained, and the catheter was secured in place. A prognostic block using an infusion of 0.25% bupivacaine at 5 mL/h was initiated for the first 2 days. On the third day a neurolytic block with 6% phenol was performed.
Marked pain relief was experienced by the patient (VAS: 0-1). Sensory block in the femoral, lateral femoral cutaneous, and obturator nerve distributions was elicited. Motor weakness in the femoral nerve was demonstrated. Narcotic use was markedly reduced, and the patient was discharged to home in a pain-free state.
This case report supports the feasibility of placing a catheter via a modified anterior inguinal paravascular block technique and its subsequent use for both local anesthetic infusion and neurolytic block of the lumbar plexus.
我们为一名47岁女性患者提供了治疗，该患者有肺癌及骨转移病史，右侧髋臼发生病理性骨折，导致右腹股沟严重且难以控制的疼痛。其疼痛在10分视觉模拟量表（VAS）上评分为8 - 10分。她的终末期疾病及较差的手术风险排除了治疗性手术干预。因此，实施了腰丛神经溶解阻滞作为一种姑息性措施。
采用改良的腹股沟血管旁（腰丛）阻滞技术。将一根17号的Tuohy针插入腹股沟区，位于股动脉外侧、腹股沟韧带下方1厘米处。将导丝穿过针，随后通过导丝将血管造影导管引入腰大肌。获得了位置的影像学确认，并将导管固定到位。在最初2天，以5毫升/小时的速度输注0.25%布比卡因进行预后阻滞。在第三天，用6%苯酚进行神经溶解阻滞。
患者疼痛明显缓解（VAS：0 - 1）。在股神经、股外侧皮神经和闭孔神经分布区域引出了感觉阻滞。证实存在股神经运动无力。麻醉药物的使用显著减少，患者出院时处于无痛状态。
本病例报告支持通过改良的前腹股沟血管旁阻滞技术放置导管及其随后用于局部麻醉药输注和腰丛神经溶解阻滞的可行性。
