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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Volume 18, Issue 1

Issues

Repetitive nerve block for neuropathic pain management: a case report

Zoher Naja
  • Corresponding author
  • Anesthesia Department, Makassed General Hospital, P. O. Box: 11-6301 Riad EI-Solh 11072210, Beirut, Lebanon, Tel.: +961 1 636 405, Fax: +9611646589
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/ Ahmad Salah Naja / Omar Rajab / Anas Mugharbil / Abdul Rahman Shatila / Janah Al Hassan
Published Online: 2018-02-10 | DOI: https://doi.org/10.1515/sjpain-2017-0155

Abstract

Schwannoma is a common neoplasm in the peripheral and central nervous systems. Sciatic nerve schwanommas are rare. We report the case of a 50-year-old woman who was referred for treatment of persistent neuropathic pain in the left lower limb after resection of a schwannoma on the left S1 nerve root. The patient’s history goes back when she was 27 years old and started to have electric-like pain in her lower left limb upon intercourse. Examination revealed a left ovarian cyst which was surgically removed. Her pain persisted despite taking nonsteroidal anti inflammatory drugs (NSAIDs). Several years later a schwannoma on the left S1 nerve root was detected. The patient had surgical excision of the left S1 nerve root at the plexus along with the schwannoma. Following the surgery, she experienced pain upon sitting and touch, and had a limp in her left leg. She was prescribed NSAIDs, antidepressant and pregabalin. Despite the pharmacological treatment, the patient had persistent mild pain. Upon physical examination, the incision from her previous surgery was 4 cm away from the sacral midline and parallel to S1 and S2. The length of the incision was 3 cm. The patient had severe allodynia upon palpation at the area between S1 and L5 and the visual analog scale (VAS) score increased from 3 to 10. She had severe pain at rest and movement. Her neurologic exam revealed that the left lower extremity motor power showed mild weakness in the leg abduction, foot eversion, plantar and toes flexion, and in the hip extension. The sensory exam showed severe reduction in pinprick and temperature sensation in the lateral aspect of foot, lower leg and dorsolateral thigh and buttocks. Nerve stimulator guided injection was performed at the pain trigger point being 1 cm above the midline of the incision. Upon nerve stimulation the contraction of the gluteal muscle was observed. Then, 20 mL of the anesthetic mixture were injected. The patient had immediate pain relief after the block (VAS 1/10). She remained pain free for 15 days after which pain reappeared but with less severity (3/10). Repetitive sciatic nerve block was performed in a progressive manner and was shown to be effective in managing neuropathic pain.

Keywords: schwannoma; neuropathic pain; repetitive nerve block

References

  • [1]

    Yamamoto T, Maruyama S, Mizuno K. Schwannomatosis of the sciatic nerve. Skeletal Radiol 2001;30:109–13.CrossrefPubMedGoogle Scholar

  • [2]

    Togral G, Arikan M, Hasturk AE, Gungor S. Incidentally diagnosed giant invasive sacral schwannoma: its clinical features and surgical management without stability. Neurosciences 2014;19:224–8.Google Scholar

  • [3]

    Omezzine SJ, Zaara B, Ali MB, Abid F, Sassi N, Hamza HA. A rare cause of non discal sciatica: schwannoma of the sciatic nerve. Orthop Traumatol Surg Res 2009;95:543–6.CrossrefWeb of SciencePubMedGoogle Scholar

  • [4]

    Consales A, Poppi M, Stumpo M. Sciatic schwannoma spanning the sciatic notch: removal by an anterior, transabdominal approach. Br J Neurosurg 2006;20:46–8.PubMedCrossrefGoogle Scholar

  • [5]

    Tan LA, Bradbury J, Bonnin J, Horn EM. Minimally invasive resection of an extrapelvic sciatic schwannoma. J Clin Neurosci 2010;17:1314–6.Web of ScienceCrossrefPubMedGoogle Scholar

  • [6]

    Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. Lancet Neurol 2010;9:807–19.Web of ScienceCrossrefPubMedGoogle Scholar

  • [7]

    Kelly DJ, Ahmad M, Brull SJ. Preemptive analgesia I: physiological pathways and pharmacological modalities. Canad J Anaesth 2001;48:1000–10.CrossrefGoogle Scholar

  • [8]

    vonHehn CA, Baron R, Woolf CJ. Deconstructing the neuropathic pain phenotype to reveal neural mechanisms. Neuron 2012;73:638–52.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [9]

    Maaliki H, Naja Z, Zeidan A. Repeated ilioinguinal block using a catheter technique for pain relief in inguinal neuralgia. Pain Pract 2008;8:144–6.PubMedCrossrefGoogle Scholar

  • [10]

    Naja ZM, Maaliki H, Al-Tannir MA, El-Rajab M, Ziade F, Zeidan A. Repetitive paravertebral nerve block using a catheter technique for pain relief in post-herpetic neuralgia. Br J Anaesth 2006;96:381–3.PubMedCrossrefGoogle Scholar

About the article

Received: 2017-10-27

Revised: 2017-12-26

Accepted: 2018-01-10

Published Online: 2018-02-10

Published in Print: 2018-01-26


Authors’ statements

Research funding: None declared.

Conflict of interest: None declared.

Informed consent: Published with the written consent of the patient.

Ethical approval: Not applicable.


Citation Information: Scandinavian Journal of Pain, Volume 18, Issue 1, Pages 125–127, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2017-0155.

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©2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

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