Lierz Peter, Schroegendorfer Klaus, Choi Seung, Felleiter Peter, Kress Hans-Georg
Department of Anaesthesiology and General Intensive Care Medicine B, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria Department of Surgery University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Pain. 1998 Nov;78(2):135-137. doi: 10.1016/S0304-3959(98)00128-6.
A 39-year-old patient developed phantom pain after amputation of both upper arms following a burn injury. The pain did not respond to naproxen, morphine, carbamazepine, amitriptyline, calcitonin or transcutaneous electrical nerve stimulation (TENS). At the 39th post-operative day an axillary catheter was placed on the right side, as well as an interscalene catheter on the left. Ropivacaine 0.2% was infused, starting with a rate of 4 ml/h, that was increased to 6 ml/h during the subsequent 6 days. Within 20 min of catheter placement complete pain relief was achieved. The patient did not need any other analgesics and remained painfree for 7 months. Neither motor block, nor any other side effects occurred during the infusion of ropivacaine 0.2%. Thus, the patient not only received analgesia, but also got an effective treatment of established phantom pain. A similar approach with bupivacaine may not have been feasible, because of the possibility of toxic side effects. Ropivacaine is a long-acting local anaesthetic which is less toxic than bupivacaine and has the additional advantage of producing less motor-blockade in the concentration used, so the patient was able to move actively without experiencing any pain.
一名39岁患者在烧伤后双臂截肢后出现幻肢痛。该疼痛对萘普生、吗啡、卡马西平、阿米替林、降钙素或经皮电刺激神经疗法（TENS）均无反应。术后第39天，在右侧放置了一根腋路导管，在左侧放置了一根肌间沟导管。输注0.2%的罗哌卡因，起始速度为4 ml/h，在随后6天内增至6 ml/h。置管后20分钟内疼痛完全缓解。患者无需任何其他镇痛药物，且7个月内一直无疼痛。在输注0.2%罗哌卡因期间，既未出现运动阻滞，也未发生任何其他副作用。因此，该患者不仅获得了镇痛效果，还对已形成的幻肢痛进行了有效治疗。使用布比卡因采用类似方法可能不可行，因为存在毒性副作用的可能性。罗哌卡因是一种长效局麻药，其毒性低于布比卡因，并且在所用浓度下产生的运动阻滞较小，还有额外的优点，即患者能够积极活动而无疼痛。
