General anesthesia as a trigger for neuropathic pain?
March 17, 2013 | 15,00 EUR | answered by Dr. med. Ralf Berg
Hello!
I will try to keep my medical history brief, although with a total of 70 operations, it is not easy! Ten years ago, I was hit by a car, underwent 4 surgeries on my ankle, and acquired a MRSA infection during the 4th surgery. I spent approximately 4.5 years in the hospital, underwent 66 more surgeries, and 4 years ago had my left lower leg amputated. I suffered from phantom pains and neuropathic pain at the stump, but I have managed to control them quite well now - without medication! Just the day before yesterday, I had my 70th operation (not on my leg, and as an outpatient) with a 4-hour general anesthesia. Upon waking up, I experienced severe burning pain in the stump, leading the anesthetist to call an ambulance with a paramedic. They took me to the hospital in Hamburg for a 20-minute ride, during which I thankfully did not feel anything. I eventually woke up pain-free in the emergency room after receiving high doses of Gabapentin. Unfortunately, the cause of this pain attack could not be determined, which is very unsettling for me! What should I do, for example, if I experience such an attack while on vacation abroad??? Could the general anesthesia have triggered the attack - even though I have had 4 other general anesthetics since the amputation, all of which were longer (about 6 hours) and were tolerated without any issues??? I am now really concerned about flying to Crete in the summer!!!
Thank you in advance for any contributions, advice, or tips you can provide! Wishing you all a wonderful and relaxing weekend,
Kind regards,
Dingsikatz
Dear patient,
as you already write in your headline: The general anesthesia was just a trigger for your neuropathic pain. Since the loss of the lower leg means that there is no longer a body part permanently present, while on the other hand in the brain this region is permanently depicted like a map of nerve cells, it is unfortunately always possible that these regions, which were fortunately "switched off", may go back online and cause "sensations" after various triggers. The burning sensation is a classic symptom of neuropathic pain. And yes, anesthesia can be a trigger for this event. The brain activity is quasi shut down by the anesthetics and then brought back up. It is not regular, but it is also not excluded that the area "lower leg" is bioelectrically reactivated, which of course must go wrong.
What can you do? Since the triggers are unknown and as your experience shows, not every anesthesia must lead to the reappearance of neuropathic pain, prophylaxis is difficult. But: You have apparently found a remedy with Gabapentin that works for you. It is normal and usual that high doses have to be administered until a effect sets in. (In contrast to Novalgin, which even in high doses has no effect on this pain pattern.) So, you should simply take this medication in sufficient dose in your travel pharmacy in case neuropathic pain could occur and enjoy your vacation.
It would also be important to know which medications the emergency doctor gave you to "distantiate" you. These apparently also had a good effect and it would be advantageous to know what substances they were in case of a new incident. (Unfortunately, there are many and the response is also individual here. I have had good experiences with Midazolam and Disoprivan (Dormicum/Propofol).
So in conclusion: Investigate this further, talk to your general practitioner so that he can prescribe Gabapentin for emergencies, if necessary. Ask him for a medical certificate so that there are no problems at customs and then off to Crete.
Best regards and enjoy your vacation,
Dr. R. Berg
P.S. I find it admirable that you have the strength and the enthusiasm to fulfill your holiday goals after this ordeal. So don't let yourself be discouraged. :)
