Neurolitička blokada opturatornog živca u lečenju idiopatske opturatorne neuralgije.

Neurolytic blockade of the obturator nerve in the treatment of idiopatic obturator neuralgia.

Introduction. Idiopathic obturator neuralgia is a rare chronic pain condition. It consists of pain radiating from the obturator nerve territory to the inner thigh. However, the symptomatic obturator neuralgia is commonly caused by the obturator canal bowel hernia that causes painful compressive neuropathy in more than 85% of the cases. Case report. A 61-year-old female who underwent right femoral amputation due to the occlusion of the aortofemoral vascular graft, complained of the pain characterized by its localization in the inguinal region and antero-internal side of the right inner thigh. Computer tomography and MRI findings excluded obturator canal herniation or lumbar plexopathy. A diagnosis of the obturator neuralgia was confirmed by an analgesic block of the obturator nerve. Thereafter, the neurolitic blockade of the right obturator nerve was done. The complete pain relief was achieved. Pain relief was complete in three-month follow-up period. Conclusion. Neurolitic blockade is an efficacious method in treating chronic pain caused by the idiopathic obturator neuralgia. [ABSTRACT FROM AUTHOR]

Uvod. Idiopatska opturatorna neuralgija redak je klinički fenomen karakterisan bolom u ingvinalnom regionu i unutrašnjoj strani butine. Simptomatska neuralgija opturatornog nerva najčešće se javlja kao posledica opturatorne hernije, kada je neuralgični bol u natkolenici vodeći simptom kod više od 85% slučajeva. Prikaz bolesnika. Bolesnica, stara 61 godinu, patila je od hroničnog bola u unutrašnjoj strani natkolenice u periodu lečenja opstruktivne arterijske bolesti. Pošto je bolni sindrom trajao i posle natkolene amputacije ekstremiteta koja je učinjena zbog okluzije grafta, postavilo se pitanje etiologije bolnog sindroma. Kompjuterizovanom tomografijom i magnetnom rezonancijom isključene su opturatorna hernija i lumbalna radikulopatija kao uzroci bola. Dijagnostičkom blokadom opturatornog živca postavljena je dijagnoza opturatorne neuralgije, a izlečenje bola postignuto je fluoroskopski kontrolisanom alkoholnom neurolitičkom blokadom opturatornog živca. Zaključak. Dijagnostička blokada živca korisna je metoda u diferencijalnoj dijagnostici etiologije bolnih stanja. Idiopatska opturatorna neuralgija maskirana kliničkim stanjem okluzivne arterijske bolesti donjih ekstremiteta kod prikazane bolesnice uspešno je izlečena neurolitičkom blokadom opturatornog nerva. [ABSTRACT FROM AUTHOR]

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