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78th Annual PostGraduate Assembly in Anesthesiology (PGA78) 2024
December 6 - 9, 2024 | New York City
3066
Managing neuropathic pain after an extensive extradigital glomus tumor of the forearm
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Managing neuropathic pain after an extensive extradigital glomus tumor of the forearm
Clinical description: 67-year-old man; chronic pain of the forearm; progressively growing glomus tumour
Day 0: Extensive exeresis of a glomus tumour on the forearm
1 year later: Moderate neuropathic pain with effective control with pregabalin 100 mg per os per day
10 months later: Aggravated, severe and incapacitating pain with allodynia and paresthesia, inflammatory signs, flictenas, cold hypersensitivity and muscular atrophy. Adjuvant opioid therapy. Multidisciplinary assessment
- Adjuvant opioid therapy: Pregabalin 150 mg per os per day; Paracetamol + tramadol (650+75 mg) po SOS; + Tapentadol 50 → 100 mg po bid
- MRI: regional relapse of the tumor with extension to the cephalic vein and mid arm. Confirmed by biopsy
- Multidisciplinary assessment → superior limb amputation
- Combined anesthesia (generalanesthesia + interscalene brachial plexus block). Uneventful surgery. Clinically discharged with: Pregabalin 100 mg po per day; Transdermal buprenorphine 20 mcg/h; Paracetamol + tramadol (650+75 mg) po SOS
1 week later: No pain. Suspension of opioid therapy (TD buprenorphine)
In the following year: No pain at the follow up visit. No need of rescue analgesia. Clinically discharged.
- Glomus tumours are benign mesenchymal neoplasms of the glomus body, a particular type of arteriovenous anastomosis.
- Significant role in thermoregulation.
- Extremely rare and difficult to diagnose.
- The most frequent locations: the nail beds, digital pulps, palms and soles.
- Classic triad (pinpoint pain, severe localized pain, and cold hypersensitivity) is rare in patients with extradigital tumours.
Our patient presented with an advanced extradigital glomus tumour causing severe chronic neuropathic pain. The surgical amputation of the affected limb provided an immediate resolution of the described pain. Considering the important risk of developing phantom pain in the amputated limb, a peripheral nerve block complemented the anaesthetic technique and the therapy with pregabalin was maintained in the post-surgical period. Although the presented case represented a challenge in the management of the presented pain, it was treated with success, without any other episodes of pain and no need for further contacts with the pain medical unit until the present moment.