The Korean Journal of Pain

  • 제16권2호
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  • Pages.262-266
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  • 2003
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  • 2005-9159(pISSN)
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  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지

전척추차단에 의한 환지통 환자의 치료 경험 -증례 보고-

A Case of Total Spinal Anesthesia for Treatment of Phantom Limb Pain - A case report-

천범수;한경림;김진수;김의석;김찬
Cheon, Bum-Soo;Han, Kyung-Ream;Kim, Jin-Soo;Kim, Yeui-Seok;Kim, Chan

  • 발행 : 20030000
⟨ 이전 논문 다음 논문 ⟩

초록

Total spinal anesthesia (TSA) has been used for the treatment of intractable pain. Its clinical use has gradually decreased, as other neuromodulative techniques, such as nerve blocks under the fluoroscopy, radiofrequency thermocoagulation lesioning and neurostimulations, have been developed. However, TSA is an easy, lesser complicated and reversible procedure, which can also be repeatedly performed. A 28-year-old man, who exhibited the signs and symptoms of phantom limb pain, following an above the knee amputation of the left leg, complained that he had felt paroxysmal electric shock-like pain and tingling, squeezing, folding and distortion of his missing ankle and foot. The previously described symptoms were decreased by 60-70% of the pretreatment state, with for weeks of continuous epidural block and the addition of ketamine, lumbar sympathetic ganglion block and medication. However, he felt an unpleasant sensation of his missing limb. Therefore, TSA was performed, and he no longer felt the unpleasant sensations of his missing limb, only mild pain in the stump region of his thigh.

키워드

참고문헌

  1. Yokoyama M, Itano Y, Kusume Y, Oe K, Mizobuchi S, Morita K: Total spinal anesthesia provides transient relief of intractable pain. Can J Anaesth 2002; 49: 810-3 https://doi.org/10.1007/BF03017413
  2. Yamashiro H, Hirano K: Treatment with total spinal block of severe herpetic neuralgia accompanying median and ulna nerve palsy. Masui 1987; 36: 971-5
  3. Jensen TS, Krebs B, Nielsen J, Rasmussen P: Immediate and long-term phantom limb pain in amputees: incidence, clinical characteristics and relationship to preamputation limb pain. Pain 1985; 21: 267-78 https://doi.org/10.1016/0304-3959(85)90090-9
  4. 대한통증학회: 통증의학. 둘째 판. 서울, 군자출판사. 2000, pp 174-89
  5. Jensen TS, Rasmussen P: Amputation. In: Textbook of pain. 3rd ed. Edited by Wall PD, Melzack R: Edinburgh, Churchill Livingstone. 1994, pp 651-5
  6. Melzack R: Phantom limb pain: implications for treatment of pathologic pain. Anesthesiology 1971; 35: 409-19 https://doi.org/10.1097/00000542-197110000-00018
  7. Burchiel KJ: Spontaneous impulse generation in normal and denervated dorsal root ganglia: sensitivity to alpha-adrenergic stimulation and hypoxia. Exp Neurol 1984; 85: 257-72 https://doi.org/10.1016/0014-4886(84)90139-0
  8. Wall PD: On the origin of pain associated with amputation. In: Phantom and stump pain. 2nd ed. Edited by Siegfried J, Zimmermann M: Berlin, SpringerVerlag, 1981, pp 2-14
  9. Bonica JJ: Management of Pain. 3rd ed. Philadelphia, Lippincott Williams& Wilkins. 2001, pp 412-21
  10. 권원석, 최준석, 박천희, 이철승, 김원태: 환지통 환자에서 경막외 meperidine의 효과. 대한통증학회지 2001; 15: 150-3
  11. Gorski DW, Chinthagada M, Rao TLK, Shah K: Epidural meperidine for phantom limb pain. Reg Anesth 1982; 7: 39-41
  12. Jacobson L, Chabal C, Brody MC: Relief of persistent postamputation stump and phantom limb pain with intrathecal fentanyl. Pain 1989; 37: 317-22 https://doi.org/10.1016/0304-3959(89)90197-8
  13. Khan MI: Phantom pain. Orthopedics 1993; 16: 1212
  14. Sunderland S: Nerves and nerve injuries. 2nd ed. Edinburgh, Churchill Livingstone. 1978, pp 453-500
  15. 대한통증학회: 통증의학. 둘째 판. 서울, 군자출판사. 2000, pp 475-6.
  16. Kimura T, Komatsu T, Hirabayashi A, Sakuma I, Shimada Y: Autonomic imbalance of the heart during total spinal anesthesia evaluated by spectral analysis of heart rate variability. Anesthesiology 1994; 80: 694-8 https://doi.org/10.1097/00000542-199403000-00032
  17. Goda Y, Kimura T, Goto Y, Kemmotsu O: Power spectral analysis of heart rate and peripheral blood flow variations during total spinal anesthesia. Masui 1989; 39: 1275-81
  18. Kotani N, Kushikata T, Hashimoto H, Kimura F, Muraoka M, Yodono M, et al: Intrathecal methylprednisolone for intractable postherpetic neuralgia. N Engl J Med 2000; 343: 1514-9 https://doi.org/10.1056/NEJM200011233432102