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Amnesia and pain relief after cardiopulmonary resuscitation in a cancer pain patient: a case report.

Chon JY, Hahn YJ, Sung CH, Moon HS - J. Korean Med. Sci. (2012)

Bottom Line: The mechanism of chronic pain is very complicated.After local anesthetics were injected, she had a seizure and then went into cardiac arrest.Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
The mechanism of chronic pain is very complicated. Memory, pain, and opioid dependence appear to share common mechanism, including synaptic plasticity, and anatomical structures. A 48-yr-old woman with severe pain caused by bone metastasis of breast cancer received epidural block. After local anesthetics were injected, she had a seizure and then went into cardiac arrest. Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared. Also, her excruciating pain and opioid dependence had disappeared. This complication, although uncommon, gives us a lot to think about a role of memory for chronic pain and opioid dependence.

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Related in: MedlinePlus

EEG of the patient. The EEG shows a partial seizure lesion and severe, diffuse cerebral dysfunction in the right temporal lobe area.
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Figure 3: EEG of the patient. The EEG shows a partial seizure lesion and severe, diffuse cerebral dysfunction in the right temporal lobe area.

Mentions: We performed a single epidural block as a trial for predicting its effect before a planned continuous epidural block using an epidural port. The epidural block was performed in the left lateral position. A 22-gauge Tuohy needle was inserted blindly into the lumbar epidural space at the L1-2 level. We used the loss-of-resistance (LOR) technique to detect the proper epidural space. After observing no leakage of cerebrospinal fluid (CSF) and blood, we slowly injected 0.4% mepivacaine hydrochloride (8 mL), without a test dose of the drug. Approximately 1 min later, the patient had a sudden seizure of generalized tonic-clonic type for 30 s, and then lost consciousness and demonstrated difficulty breathing. Immediately, artificial respiration was performed on her. At that time, her blood pressure (BP) level was 100/80 mmHg, and her heart rate (HR) was 60 beats/min. We immediately attached monitoring devices to her body. The patient was intubated with an endotracheal tube, mechanically ventilated, and her condition was monitored closely. Later, she went into cardiac arrest. We performed CPR for 5 min until her cardiac rhythm returned to normal. Her vital signs were as follows: BP, 110/50 mmHg; HR, 120 beats/min; body temperature, 36.5℃; respiratory rate, 20/min; SpO2, maintained at 100%. A neurologic assessment by a neurologist did not reveal any neurological abnormalities other than unconsciousness. Brain computed tomography (CT) scan did not show any specific abnormal findings. We performed brain magnetic resonance imaging (MRI) (Fig. 2) twice, but neither scan showed any abnormalities except metastatic lesions in the meninges and bones. Electroencephalography (EEG) (Fig. 3) showed a partial seizure lesion and severe, diffuse cerebral dysfunction in the right temporal lobe area. After 14 days, we performed another EEG again, which showed same results. Anticonvulsants were not administered because she did not have seizure any more. She was transferred to the intensive care unit. Seven days later, she opened her eyes in response to her name. She made eye contact with the medical team, grasped her hand, and responded to the doctor's requests. After 16 days, we removed her endotracheal tube. After 17 days, she could have simple conversations with her husband, and started communicating fluently after 22 days. Although no neurologic sequelae remained, she could not remember her 3 yr of autobiographic memory prior to the incident, and the severe pain of which she had complained had almost disappeared (VAS 1/10). Opioid withdrawal symptoms were not observed. Morphine was no longer needed. She was moved to a general ward.


Amnesia and pain relief after cardiopulmonary resuscitation in a cancer pain patient: a case report.

Chon JY, Hahn YJ, Sung CH, Moon HS - J. Korean Med. Sci. (2012)

EEG of the patient. The EEG shows a partial seizure lesion and severe, diffuse cerebral dysfunction in the right temporal lobe area.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3369462&req=5

Figure 3: EEG of the patient. The EEG shows a partial seizure lesion and severe, diffuse cerebral dysfunction in the right temporal lobe area.
Mentions: We performed a single epidural block as a trial for predicting its effect before a planned continuous epidural block using an epidural port. The epidural block was performed in the left lateral position. A 22-gauge Tuohy needle was inserted blindly into the lumbar epidural space at the L1-2 level. We used the loss-of-resistance (LOR) technique to detect the proper epidural space. After observing no leakage of cerebrospinal fluid (CSF) and blood, we slowly injected 0.4% mepivacaine hydrochloride (8 mL), without a test dose of the drug. Approximately 1 min later, the patient had a sudden seizure of generalized tonic-clonic type for 30 s, and then lost consciousness and demonstrated difficulty breathing. Immediately, artificial respiration was performed on her. At that time, her blood pressure (BP) level was 100/80 mmHg, and her heart rate (HR) was 60 beats/min. We immediately attached monitoring devices to her body. The patient was intubated with an endotracheal tube, mechanically ventilated, and her condition was monitored closely. Later, she went into cardiac arrest. We performed CPR for 5 min until her cardiac rhythm returned to normal. Her vital signs were as follows: BP, 110/50 mmHg; HR, 120 beats/min; body temperature, 36.5℃; respiratory rate, 20/min; SpO2, maintained at 100%. A neurologic assessment by a neurologist did not reveal any neurological abnormalities other than unconsciousness. Brain computed tomography (CT) scan did not show any specific abnormal findings. We performed brain magnetic resonance imaging (MRI) (Fig. 2) twice, but neither scan showed any abnormalities except metastatic lesions in the meninges and bones. Electroencephalography (EEG) (Fig. 3) showed a partial seizure lesion and severe, diffuse cerebral dysfunction in the right temporal lobe area. After 14 days, we performed another EEG again, which showed same results. Anticonvulsants were not administered because she did not have seizure any more. She was transferred to the intensive care unit. Seven days later, she opened her eyes in response to her name. She made eye contact with the medical team, grasped her hand, and responded to the doctor's requests. After 16 days, we removed her endotracheal tube. After 17 days, she could have simple conversations with her husband, and started communicating fluently after 22 days. Although no neurologic sequelae remained, she could not remember her 3 yr of autobiographic memory prior to the incident, and the severe pain of which she had complained had almost disappeared (VAS 1/10). Opioid withdrawal symptoms were not observed. Morphine was no longer needed. She was moved to a general ward.

Bottom Line: The mechanism of chronic pain is very complicated.After local anesthetics were injected, she had a seizure and then went into cardiac arrest.Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT
The mechanism of chronic pain is very complicated. Memory, pain, and opioid dependence appear to share common mechanism, including synaptic plasticity, and anatomical structures. A 48-yr-old woman with severe pain caused by bone metastasis of breast cancer received epidural block. After local anesthetics were injected, she had a seizure and then went into cardiac arrest. Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared. Also, her excruciating pain and opioid dependence had disappeared. This complication, although uncommon, gives us a lot to think about a role of memory for chronic pain and opioid dependence.

Show MeSH
Related in: MedlinePlus