Reactions 1255 - 6 Jun 2009

SBupivacaine

Phantom limb pain during spinal anaesthesia inan elderly amputee: case report

For two consecutive surgeries, a 68-year-old amputeeexperienced phantom limb pain during spinal anaesthesiawith bupivacaine; on both occasions, he was treatedeffectively with midazolam.

The man, who had peripheral artery occlusive disorderand had undergone below-knee amputation of his right leg10 years earlier, presented for below-knee amputation ofhis left leg. Spinal anaesthesia was induced at theL3-4 interspace with bupivacaine 10mg, and he was placedin the supine position and preparation for surgery wasstarted. Ten minutes later, he reported continuous, severetingling and burning sensations in his right stump; he had apain intensity of 10 according to the visual analogue scale.Tests revealed loss of sensation to cold up to the T10 level,and he could not move his legs.

The man received IV midazolam 3mg, but his pain wasnot completely relieved. He then received a further 2mg ofmidazolam and became sedated. When he wokeapproximately 15 minutes after receiving the secondmidazolam dose, the phantom limb pain had resolved, anddid not recur.

Three weeks later, the man underwent surgery fordebridement of the left stump. Again, he received spinalanaesthesia with bupivacaine 10mg. However, 10 minutesafter receiving the drug, the phantom limb pain in his rightleg returned; the pain intensity was half as severe as on theprevious occasion. He received midazolam 3mg, with painrelief. At follow-up on postoperative day 2, there was norecurrence of phantom limb pain.Su C-J, et al. Midazolam as an effective drug for severe phantom limb pain in apatient after undergoing spinal anesthesia for two consecutive surgeries in thecontralateral lower limb. Acta Anaesthesiologica Taiwanica 47: 32-35, No. 1, Mar2009 - Taiwan 801141758

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Reactions 6 Jun 2009 No. 12550114-9954/10/1255-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved