BACKGROUND AND OBJECTIVES: Neuropathic pain is difficult to treat and many patients have partial and incomplete pain relief with pharmacological treatment. When the neuropathic pain has traumatic origin one should consider the possibility of treating with surgical exploration because pain may be caused by nervous compression due to adjacent tissues fibrosis or sheath thickening. This study aimed at presenting a successful case of surgical treatment of neuropathic pain caused by sheath thickening of left sciatic nerve, caused by firearm injury. CASE REPORT: Male patient, reached by firearm shot in the left gluteus region, who evolved with burning pain in the posterior left thigh region, with irradiation to the posterior thigh face, leg and foot, which was partially controlled with pharmacological treatment with oxycodone, gabapentin and amitriptyline. As pain persisted, surgical exploration was performed at the bullet entry site, which has evidenced the presence of left sciatic nerve bulb and sheath thickening, being performed endoneurolysis for intraneural fibrosis decompression. After surgery, patient was treated with pregabalin, morphine and amitriptyline and 10 months after surgery he was asymptomatic and no longer having medication. CONCLUSION: Surgical treatment with endoneurolysis for intraneural fibrosis decompression in left sciatic nerve associated to treatment with amitriptyline and pregabalin has successfully controlled neuropathic pain caused by firearm injury.
Anticonvulsants; Antidepressants tricyclics; Femoral neuropathy; Pain; Surgical intervention
