受傷早期から硬膜外ブロックによるとう痛管理を行った腕神経叢損傷の２症例

Abstract

Brachial plexus injury often causes severe chronic upper limb pain that persists for a long time. We present 2 cases in which brachial plexus avulsion pain was managed by epidural block. Brachial plexus avulsion caused by motorbike accidents elicited severe abnormal sensations in the upper limbs, where there was complete loss of motor and sensory neurological functions. There was continuous burning and intermittent cutting pain such as causalgia in the forearm of 1 patient and an oppressive sensation such as extraction of the upper arm from the shoulder in the other patient. Continuous cervical epidural blocks were applied to both patients immediately, resulting in obvious reduction in the degree of acute pain and in the induction of chronic pain in the upper limbs. This suggests that application of cervical epidural block in the early phase is an effective therapy for patients suffering brachial plexus injury for inhibiting the chronic upper limb pain. Note that should notice application of satisfactory analgesia even in emergency cases should be as fast as possible if there is a possibility that trauma will lead to chronic pain.