Low Dose Midazolam for Prevention of Spinal Anesthesia-Induced Phantom Limb Pain

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概要

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• Spinal anesthesia occasionally induces temporary but severe phantom limb pain in patients with a prior lower extremity amputation. Furthermore, there have been reports that spinal anesthesia induces severe lightning pain in the lower limb of patients with tabes dorsalis, diabetic neuropathy, subacute myelo-optico-neuropathy, and leprosy. We report a case in which midazolam completely prevented the generation of spinal anesthesia-induced phantom limb pain.A 78-year-old man was scheduled for ureterocystoscopy. The patient had undergone right lower limb amputation 47 years previously, but had no history of phantom limb pain. Spinal anesthesia was uneventfully introduced using bupivacaine, which caused severe phantom limb pain occurred within five minutes. Intravenous administration of 2.0mg midazolam abolished the pain completely. The patient underwent ureterocystoscopy again 10 days later. After intravenous administration of 1.0mg midazolam, spinal anesthesia was uneventfully introduced. This time, no phantom limb pain developed throughout the examination.Midazolam abolished phantom limb pain in the first intervention and might have prevented its appearance in the second. As possible mechanisms, midazolam may inhibit abnormal firings at the dorsal horn level, and/or rapid decrease in GABA levels in the sensorimotor cortex, both associated with deafferentation by spinal anesthesia.This case suggests that preemptive administration of midazolam can prevent the development of spinal anesthesia-induced phantom limb pain.

• 一般社団法人 日本ペインクリニック学会の論文

一般社団法人 日本ペインクリニック学会 | 論文

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