Successful Therapy Of Phantom Pain In The Upper Limb By Blocking The Brachial Plexus

摘要

Early treatment of phantom limb pain in patients after amputation reduces the incidence of chronic pain sensations from 60 - 85 % to 10 - 20 % [1]. A 33 year old patient with osteosarcoma of proximal humerus developed a burning pain VAS 7-8 (Visual analog scale 0-10) of the left hand and fingers three days after amputation of the left arm in the shoulder joint. Treatment with calcitonin, amitriptyline, naproxen, piritramide and carbamazepine did not influence the pain. On the seventh day an interscalene block was done with the use of a nerve stimulator. After a bolus of 30 ml ropivacaine 0.2 % was infused with a rate of 6 ml/h for ten days. Within a time period of ten minutes the phantom limb pain was relieved (VAS 0). After four hours phantom limb sensations developed, but were not classified as pain by the patient. With the option of a patient controlled bolus of 5 ml (2x /h) it was possible to reduce the additional pain therapy to carbamazepine and amitriptyline. During the ropivacaine treatment no motor blockade or other side effects were observed.