Drezotomy in the management of post brachial plexus injury neuropathic pain: Preliminary results

Abstract

ObjectiveTo share our experience of DREZOTOMY in the management of post brachial plexus injury neuropathic pain. MethodRecords of patients with severe neuropathic pain following brachial plexus injury who underwent microsurgical C4-T1 DREZOTOMY were analyzed. Pain relief in the immediate postoperative period, 6 weeks and 6 months was analyzed. ResultsTotal of 7 patients from July 2010 to May 2013 were included in the study. Mean age was 41.1 (26–63). There were 6 male and 1 female patients. Five patients had right-sided pain and 2 had left sided dysesthetic pain. All patients had intractable pain not relieved by medications and was affecting their activities of daily living (ADL's). After psychological counseling and detailed analysis cervical laminectomy and DREZOTOMY was performed. Findings were that the posterior rootlets were absent from the DREZ, arachnoid over the area was dull and multiple microcysts were present. Pain relief was assessed in the immediate postoperative period and later. Control of pain was graded as absence or minimal pain, requiring minimal or no analgesics in 3 patients (VAS 0 OR 1), moderate pain as requiring atypical analgesics in 4 patients (VAS 3–4). Pain control at 6 weeks follow up was good for 2 and moderate for 2 patients. At 6 months showed good pain relief in 2 patients and moderate for 2. ConclusionPatients whose ADL'S are affected by such pain, microsurgical DREZOTOMY can provide good relief thereby helping them to get back to a better quality of life post trauma.