Background and aims An 18-year-old female presented for the treatment of acute on chronic neuropathic pain in the right leg. The chronic neuropathic pain developed due to pressure of giant cell tumor on the sacral nerves S1 to S3 (figure 1). The tumor was removed.
The current medical history started at admission to the hospital due to extreme neuropathic pain crises in the right lower extremity (figure 2). Pain treatment consisting of pregabalin, amitryptiline, morphine, midazolam, ketamine, lidocaine, and oxycontin was insufficient with maximal pain scores.
Methods Epidural analgesia was then considered. The epidural catheter was retrogradely positioned at the level of right S2 root. Following treatment by an epidural continuous infusion of levobupivacaine 0.125% (6 mL/hr), the patient became pain free with only occasional breakthrough pain (NRS 6–7) which was managed by boluses (6 mL/10 min). The urinary bladder catheter was removed on day 8 and on day 15 the patient was allowed for short home visit.
Results The epidural infusion of levobupivacaine 0.125% was continued for 28 days. During this period, she experienced neither motor block nor urinary bladder dysfunction. After removal of the catheter, sensory block persisted at the level of S1-S3 dermatomes on the right side. Duration and asymmetrical location of the remaining sensory block is suggestive of invasion of the sacral plexus by the tumor as primary cause rather than the prolonged administration of the local anesthetic.
Conclusions This case report demonstrates that intractable neuropathic pain at the lower limb can be successfully treated with a prolonged epidural infusion of local anesthetics, without complications.
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