Serbian Journal of Anesthesia and Intensive Therapy (Jan 2018)
The role of sonographically guided alcohol instillation in treating painful neuroma: Sonographically guided alcohol instillation
Abstract
Introduction: Traumatic stump neuroma is a disorganized proliferation of nerve fascicles occurring after limb amputation. Neuromas may also form during regeneration after a nerve injury. Symptoms of stump neuroma can vary, from the painless presence of neuromas, to the development of a strong pain that does not respond to the applied conservative therapy. Case report: Fifty-two years old male patient, who had amputation of both legs: left - above; and right - below the knee, facing a strong intermittent stabbing pain in the distal part of the left leg stump, the strength at the VAS scale from 9 to 10. To date, he had several surgical interventions and infiltration of the left sciatic nerve by local anesthetics. The first surgical intervention involved excision of neuroma of left sciatic nerve and then reintervention was performed with additional excision and implantation of fasciculi of sciatic nerve to the muscles. Surgical interventions did not significantly improve his general condition and reduced pain intensity. The patient used many medications and their combinations to reduce pain. Since pain in the patient ranges from VAS 5 to VAS 9 in the last few months, it has been decided to infiltrate alcohol into the area where the neuroma surgically removed from the left leg stump and to do this under ultrasound control. For a month, the patient was not feeling the pain he had endured for years. The precise placement of the needle and the application of alcohol in the neuroma was made possible by the use of ultrasound. Conclusion: Ultrasound-guided application of alcohol directly in the neuroma is a safe method and is easy to perform. It can be a very successful therapeutic option for the treatment of chronic pain after injuries or amputation of the extremity that comes from the stump neuromas. The most common result of this procedure is an immediate improvement, even after a single instillation. For patients with large neuromas, further instillations are required.
