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A Series Ultrasound-Guided Coracoid Infraclavicular Block for Complex Regional Pain Syndrome-A Case Report

 曾光毅(Kuang-Yi Tseng);蔡承靜(Chen-Gin Tsai);盧奕丞(I-Chen Lu);王富元(Fu-Yuan Wang);王迎椿(David Wang);湯兆舜(Chao-Shun Tang)
Ultrasound-guided peripheral nerve block, provided excellent sensory and motor blockades with fewer adverse events for most peripheral regional anesthesia. The benefits of directly visualizing targeted nerve structures and monitoring the distribution of local anesthetic are significant. We applied this technique to improve quality of coracoid infraclavicular block for a patient who suffered from intractable pain caused by complex regional pain syndrome (CRPS) and taken high dosage of opioids. A 50-year-old man, 49kg in body weight, was diagnosed as complex regional pain syndrome (CRPS) type I 4 years ago and visited our pain clinic for opioids medication and deep cervical block (C4, C6) every week since then. The current mainstay of analgesic regimen was fentanyl patches (50μg/hr) q2d, and oral morphine with average dosage around 60-90mg. We expected to achieve better pain relief by applying a series of ultrasound-guided coracoid infraclavicular block as an adjuvant therapy. All blocks were performed using ultrasound visualization with a high resolution linear probe. The anesthetic mixture consisted of 10ml of ropivacaine 1% and lidocaine hydrocarbonate 2% with epinephrine 1:200,000. The spread of the solution around the subclavian artery could be visualized using our imaging probe. We evaluated analgesic effect of the blockade with daily morphine consumption, visual analog scale, frequency and duration of pain. Gradually, his intractable pain was controlled with much satisfaction.
超音波指引之週邊神經阻斷術,因可以直接看見目標神經構造與觀察局部麻醉劑擴散,對於絕大多數的上肢區域麻醉提供相當優良之感覺與運動阻斷而且少有副作用。我們應用超音波指引之鎖骨下神經阻斷術,作為一位使用大量成癮性止痛藥之上肢複雜性區域疼痛症候群患者的輔助止痛方式。我們報告一位體重49公斤之50歲男性,被診斷上肢複雜性區域疼痛症候群已四年。期間於本院疼痛科門診使用成癮性止痛藥並接受第四、六頸椎之深部神經阻斷作為疼痛控制。目前成癮性止痛藥用量為fentanyl patches (50μg/hr)每兩日一片,口服嗎啡每日約60-90mg。我們應用超音波指引之一系列鎖骨下神經阻斷術作為輔助止痛方式,預期能達成更好的疼痛控制品質。所有的神經阻斷均在超音波探頭的影像下操作,使用的局部麻醉劑為10ml之1% ropivacaine與2% lidocaine混合溶液;在超音波的影像下可觀察到溶液分布於鎖骨下動脈周圍。我們以下述指標判斷此方式之止痛效果,包含每日口服嗎啡消耗量、疼痛量表、疼痛頻率與持續時間。結果患者於一系列治療後得到較滿意之疼痛控制。