A 72 year old lady was reviewed in the Pain Clinic with pain in the right hand and index finger. She had 2 carpal tunnel operations, the last one 3 years ago on the right hand. It appeared that during the local anaesthesia, there was an inadequate block and this had to be finished off under general anaesthetic. However, post operatively, she had a lot of discomfort and pain in the wrist.
Presntation to the Pain Clinic
She presented to the Pain Clinic with pain in the right hand. Of note, she had a carpal tunnel scar on the palmar surface of the hand and there were elements of pain on light touch (allodynia) and excessive pain on pinprick sensation (hyperalgesia), which were fairly widespread.
There was also no movement of the index finger and she complained bitterly of pins and needles in the fingers. She also had pain 3-4 times per day which felt like intermittent sharp needles and she was very distressed by it.
Diagnosis and Treatment
She was diagnosed as having postoperative neuropathic pain.
The patient was started on Gabapentin 200 mg nocte; a small dose was chosen as she was on haemodialysis. She was also given Tramadol 50 mg as required.
Progress following treatment
At 2 weeks she was found to have made good progress and at 2 months she was making good progress with a reduction in the intensity of the pain and her only adverse effect was some slight tiredness. Otherwise, she was happy with her dosage of medication and decided to stick with this. The plan is to continue her on this dosage for the next 4-5 months before considering weaning it down