I had a pain pump installed, but I still felt extreme pain after the operation. What was the reason?

Not long after the thyroid surgery patient was sent back, the ward called: the patient was in pain, and asked the anesthesiology department to take care of it.

Dr. Liu, who was in charge of this anesthesia, was currently performing anesthesia for the second operation.

During the process, we received several calls from the surgery department. However, since the anesthesia department was always short of staff, no one could go to check the cause, so we had to ask them to wait a little longer.

During this time, Dr. Liu was thinking: This is impossible. The operation just ended, so theoretically there is still some anesthetic in the body. Besides, there is a postoperative analgesia pump, and generally speaking, the patient will not feel much pain. Puzzled, he could only try his best not to be distracted and perform anesthesia for the second operation.

Finally, the department director arrived. He quickly put on his outdoor clothes and went to the ward to check.

When I was almost at the ward, I ran into the patient's family. Although there was still some distance between us, I could clearly sense the dissatisfaction in their eyes. It looked like if I didn't give an explanation or solve the problem immediately, this matter would not be over.

Dr. Liu was anxious and nervous. After all, this situation was difficult to explain.

The first thing to do when entering the ward is to check whether the analgesic pump is working properly. If the analgesic pump is working properly, it should be no problem to deal with general pain.

After checking, the pain pump was fine.

Seeing the patient's painful expression and sweat on his forehead, it was obvious that he was in pain. But where did the pain come from? For a moment, Dr. Liu was unsure.

The most urgent task is not to analyze the cause of the pain, but to eliminate the symptoms. The patient's pain level and the family's dissatisfaction did not give Dr. Liu more time to think.

After taking another shot of painkillers, it seemed to have no effect. He tried to take another half shot, but it still had no effect. The continued high temperature in the ward had soaked Dr. Liu's isolation suit. Sweat was also swirling in his hat.

The more this happens, the more you need to stay calm: the analgesics that have been injected can theoretically suppress normal pain. Even if the pain is very intense, it will have a certain effect, and the patient will not be in so much pain. There must be other reasons!

Thinking of this, Dr. Liu carefully analyzed every detail.

Suddenly, the detail that the patient said he had cervical spondylosis before the operation popped into his mind. Could it be that the pain was caused by the supine position of the neck during the operation?

If the pain is caused by cervical spondylosis, it is usually neck pain. However, when Dr. Li put his hand into the patient's occipital region, the patient's originally irritable expression turned into extreme pain and he screamed. Obviously, the occipital region was very painful.

While comforting her, he touched her neck muscles with his hands and she cried out in pain again.

The pain site was found, but what caused it? Doctor Liu quickly analyzed the cause.

Anatomy is the strong point of anesthesiologists, so Dr. Liu analyzed which nerve in the head and neck had problems.

The occipital region is usually the greater and lesser occipital nerves. The lesser occipital nerve runs upward along the posterior edge of the sternocleidomastoid muscle and sends out cutaneous branches to innervate the posterolateral scalp and auricle. Therefore, the suspicion can be basically ruled out.

However, the greater occipital nerve cannot be ruled out as a suspect. The greater occipital nerve is composed of C2 posterior branch nerve fibers, with a small amount of third cervical nerve fibers flowing into it. The C2 posterior branch is the thickest branch of the posterior branch of the spinal nerve. The greater occipital nerve is the medial branch of the C2 posterior branch, running along the occipital artery in the fascia just below the superior nuchal line, innervating the posterior medial scalp, and reaching forward to the top of the head. Its course is close to the atlantoaxial joint, and it twists and turns through the muscles and fascia many times, which is the anatomical basis for the greater occipital nerve to be easily damaged.

Considering her cervical spondylosis and the supine position of her neck during the operation, this is most likely the reason.

The amount of intravenous medication is already very large, and no more can be added. Is there any other way? Doctor Liu thought about it in his mind.

Dr. Liu's previous experience of treating occipital neuritis with the pain department immediately came to his mind. So he immediately communicated with the family to perform occipital nerve block.

However, the family members were already furious and wanted to beat up Dr. Liu. When he said he was going to do a nerve block on the patient, he didn't ask anything else, but directly asked: Do you want more money? The pain pump is not enough? How much money do you want to make? !

Dr. Liu, who had already anticipated the patient's dissatisfaction, could only bear with the explanation.

Fortunately, the family agreed, and the patient was quickly blocked under ultrasound.

After the operation, the pain was significantly relieved, but it was still very uncomfortable.

At this time, Dr. Liu thought: Could it be that the long-term compression of the neck tissue caused ischemia and spasm?

When my hands pressed on the muscles at the back of my neck, I indeed cried out "Ah".

There is no good way to treat the spasm and pain in this area, and the only option is massage. In theory, cervical plexus block can also be performed, but it can only solve one side, and I dare not block both sides. Besides, it is not reasonable to block another cervical plexus. So, Dr. Liu went up to massage himself, hoping to relieve the patient's pain through massage.

At this time, Dr. Liu felt mixed emotions, but the family members may never know how he felt. I believe every medical staff has had this experience.

After a while, the pain was relieved a little, but the patient was still frowning, so the nurse gave him another injection of a neuroleptic sedative.

Not long after, the patient's eyebrows finally relaxed.

This incident reminds everyone: If the neck is in the supine position for a long time, you need to pay attention to the problem of compression of the neck tissue or nerves. If the operation is long, try to seize the territory between the middle and the surgical department, adjust the head angle back for a while, and let the patient's neck rest for a while. If pain complications occur, actively deal with them, and pay attention to the additional factors of anxiety caused by the patient's inability to raise his head and move.

Xiao Shaowen, Department of Anesthesiology, Guangzhou Nansha District Sixth People's Hospital

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