#36245 Treatment of neuropathic pain with peripheral nerve block: case report

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Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Background and Aims Intraoperative nerve injuries caused by the patient’s positioning are surgery’s undesirable complications, that might occur despite preventive measures and lead to sensory and motor deficits and neuropathic pain. This work aims to describe a clinical case of a patient who developed neurological deficits in the territory of the common peroneal nerve (CPN) after a meningioma’s excision. The patient gave consent to this clinical case presentation. Methods A 49-year-old woman underwent a temporal meningioma removal. In the postoperative period, the patient developed incapacity of dorsiflexion of the feet bilaterally and intense neuropathic pain (8/10), with a daily sensation of electric shocks and burning. The electromyography test revealed signs of bilateral involvement of the CPN, above the peroneal head, with severe axonal damage, more significantly at the left side. The patient was initially prescribed with a therapeutic plan that included gabapentin and physiotherapy, showing mild benefits. However, although presenting a moderate improvement of the neuropathic pain, the patient maintained a relevant and disabling clinical condition. Therefore, a peroneal nerve block (PNB) was proposed. Results The patient underwent an ultrasound-guided bilateral PNB, administering 2 ml of 0.2% ropivacaine and 20 mg of methylprednisolone on each side. The patient described an immediate improvement in the neuropathic pain score (2-3/10) and could walk without crutches. In the following months, the patient referred a sustained improvement in the pain score and autonomy. Conclusions These results show that ultrasound-guided blockade using 0.2% ropivacaine and methylprednisolone could be a safe and effective treatment in patients with nerve injury and neuropathic pain.

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