Background & Aims
Post-surgical pain pain can continue to make the patient suffer even after the wound recovers.
Compartment syndrome is caused by excessive pressure on the compartment where the body’s muscles are located. Excessive body compartment pressure increases at this time reduce blood supply and can cause nerve damage and muscle ischemia, and it can cause peripheral neuropathy.
Methods
59-year-old man who had no other medical problems was diagnosed with baker’s cyst in his left knee and underwent fasciotomy and vascular reconstruction with compartment syndrome due to popliteal artery and vein involvement.
The results suggesting denervation and reinnervation of Lt. tibial and peroneal nerve were confirmed in the postoperative neurosurgical test, and the patient was then admitted to the pain clinic as allodynia and dysesthesia of VAS score 9/10 in the left lower extremity. There was a response to nerve block, especially after the lumbar sympathetic ganglion block was performed, the pain was greatly improved with VAS score 3/10. But, the duration was not longer than 1 week, so a pulsed radiofrequency ablation was planned for the lumbar sympathetic ganglion. Ablation was performed on L2, L3, and L4 respectively using a radiation device in consideration of the anatomical location of the lumbar sympathetic ganglion.
Results
The patient’s VAS score decreased to less than 3/10, and outpatient follow-up and drug treatment were performed for 6 months, and until now, pain has been controlled by drug treatment and intermittent intravenous lidocaine infusion.
Conclusions
The relationship between the sympathetic nervous system and pain is complex. In a healthy person, the sympathetic nervous system suppress acute pain through the descending inhibitory pathway for noxious stimuli, but in a state in which the sympathetic nervous system is chronically activated, the sympathetic nervous system causes pain.
For the treatment of sympathetic pain, local anesthetic sympathetic block, IV regional sympathetic block, and systemic alpha-adrenergic blockade can be used.
pulsed radiofrequency ablation can be considered as the next step, and further, surgical sympathectomy or neurolytic procedure can be considered.
References
1 McQueen, M. M., P. Gaston, and C. M. Court-Brown. “Acute compartment syndrome: who is at risk?.” The Journal of bone and joint surgery. British volume 82.2 (2000): 200-203.
2 Díaz, Roberto Carlo Rivera, et al. “Compartment syndrome of the upper limbs after bee sting: Case report.” Colombian Journal of Anesthesiology 42.1 (2014): 65-69.
3 Phuphanich, Melissa E., et al. “Sympathetic Blocks for Sympathetic Pain.” Physical Medicine and Rehabilitation Clinics 33.2 (2022): 455-474.
Presenting Author
Jiyong Lee
Poster Authors
Topics
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral