CONTINUOUS BLOCKADE OF BOTH BRACHIAL-PLEXUS WITH ROPIVACAINE IN PHANTOM PAIN - A CASE-REPORT

A 39-year-old patient developed phantom pain after amputation of both upper arms following a burn injury. The pain did not respond to naprox en, morphine, carbamazepine, amitriptyline, calcitonin or transcutaneo us electrical nerve stimulation (TENS). At the 39th postoperative day an axillary catheter was placed on the right side. as well as an inter scalene catheter on the left. Ropivacaine 0.2% was infused, starting w ith a rate of 4 ml/h, that was increased to 6 ml/h during the subseque nt 6 days. Within 20 min of catheter placement complete pain relief wa s achieved. The patient did not need any other analgesics and remained painfree for 7 months. Neither motor block, nor any other side effect s occurred during the infusion of ropivacaine 0.2%. Thus, the patient not only received analgesia, but also got an effective treatment of es tablished phantom pain. A similar approach with bupivacaine may not ha ve been feasible, because of the possibility of toxic side effects, Ro pivacaine is a long-acting local anaesthetic which is less toxic than bupivacaine and has the additional advantage of producing less motor-b lockade in the concentration used, so the patient was able to move act ively without experiencing any pain. (C) 1998 international Associatio n for the Study of Pain. Published by Elsevier Science B.V.