ULTRASOUND GUIDED PAIN INTERVENTIONS FOR

MANAGEMENT OF MEDICALLY CHALLENGED NEUROPATHIC PAIN- A CASE SERIES

Babita Ghai1

, Nitika Goel1

, Mehvish Bhalla3

1Department of Anaesthesia,

Post Graduate Institute of Medical Education and Research, Chandigarh, India-160012

Introduction

Results/Case Report

Conclusion

ü In certain neuropathic pain conditions, posing diagnostic and management

challenges,

ü ultrasound-guided peripheral nerve blocks play a valuable role in improving

precision, safety and clinical outcomes, as well as they are helpful in titrating

pain medications and opioid overuse.

ü This challenging case series emphasises our experience in management of

certain neuropathic pain conditions through ultrasound-guided peripheral

nerve blocks; highlighting the role of USG peripheral nerve blocks as a

rescuer in refractory challenging chronic pain cases.

Material and Methods

ü As the case report is devoid of patient identifiable information, it is exempt from

IRB review of PGIMER Chandigarh.

ü Case 1-Small Fibre sensory neuropathy: 16 year old male, with pain, paraesthesia

and severe allodynia for past 2 years on the distal half of both soles. USG guided

tibial nerve block with 0.25% bupivacaine and 40 mg depomedrol on each side.

ü Case 2- 38 year old female with Peroneal neuralgia following fracture left distal

tibia and fibula and intramedullary nailing of 3 years back. USG Guided superficial

peroneal block with 0.25% Bupivacaine and 60mg of methyl prednisolone

ü Case 3- 50 year old male with isolated Peroneal neuralgia following superficial

peroneal neurectomy post disctectomy, superficial peroneal nerve block given with

5ml of 0.5% Bupivacaine and 60mg of methyl prednisolone

ü Case 4-Ulnar Neuralgia following Upper limb CRPS post stellate Ganglion

intervention. Ulnar nerve block with 0.2% Ropivacaine and 80mg of

ü methyl prednisolone

ü Case 1:

ü Patient reported 90% and 100% symptom relief on right and left side respectively

immediately after the posterior tibial MIPSI. Presently at 12

ü months of follow up, NRS for pain is 1/10, patient is able to walk without support and

sleeps for 8-10 hours without interruptions.

ü Case 2: Post procedure, at 2 years, she had 99% pain relief. NRS reduced to 3/10

at fractured nailing site. Now patient could easily flex left knee

ü that she was unable to perform due to nerve pain. She had relief from heaviness

that was felt while walking.

ü Case 3: Diagnostic block provided good pain relief and improved his gait. Thereafter

we performed pulsed radiofrequency ablation of the same.

ü Now at 1 year the patient NRS of 2/10 from baseline score of 10/10.

ü Case 4: Following ulnar nerve block, at 1.5 Years, patient had complete pain relief with NRS

decreasing from 9 to 3 out of 10.

This case series highlights the role of ultrasound guided peripheral nerve blocks as a rescuer in

certain challenging chronic pain cases. In all these

cases, a variety of neuropathic pain medications were tried, definitive pain interventional

procedures were also practiced. However when they did

not provide adequate pain relief or in cases of residual pain after the main procedure,

ultrasound guided peripheral nerve blocks played a huge role

in such refractory challenging chronic pain conditions.

References

1. Chhabra A, Andreisek G, Soldatos T, et al. MR neurography: past, present, and

future. AJR 2011; 197:583–591

2. Chhabra A, Carrino J. Current MR neurography techniques and whole-body MR

neurography. Semin Musculoskelet Radiol 2015; 19:79–

85

Disclaimer: None of the authors have any conflict of interest.