Intractable Neuropathic Pain Treated by Ultrasonoguided Peripheral Nerve Block

초록

A fourtysix old gentleman has suffered crush injury just below knee joint level. He has communited open fractures (left proximal tibia and fibula) with popliteal area neurovascular injury. After injury he continuously complainted on the deep aching pain on leg. This pain has not been controlled by Targin (oxycodone+naloxone), IV boxter (Sufental) and also Pethidine (IV) 4 times a day. But the pain persisted more than VAS 8. The arteriogram showed post-traumatic vascular narrowings without obvious vascular lesion. High resoultion ultrasonography revealed operative scar tissue adhesion on the posterior tibial and common peroneal nerves. We used ultrasonoguided epineurial block (triamcinolone with 0.5% lidocaine), and after that the pain reduced to VAS 2. We have experienced one case successfully treated causalgia with sonoguided epineural nerve block on peripheral nerve (common peroneal and tibial nerves).