42 Indian Journal of Pain | January-April 2014 | Vol 28 | Issue 1 Beneficial effect of intravenous nitroglycerin and lidocaine in severe pain due to acute arterial occlusion Introduction Acute arterial occlusion is sudden cutoff of blood flow in a limb that can be a threat to limb viability and is often with severe pain. Abdominal acute arterial occlusion is an internal emergency because it can be a threat to limb’s viability and it usually origins from the heart. [1] Diagnostic methods for acute arterial occlusion including magnetic resonance imaging (MRI), computed tomography (CT) scan, and angiography. Ischemic pain is a nociceptive pain and nonsteroidal ant-inflammatory drugs (NSAIDs) and opioid are the most common medical therapy. Sometimes severe pain does not respond to these therapies. Acute ischemia of limb can result in highly dysfunction, amputation (30%) and death (20%). [2] Access this article online Quick Response Code: Website: www.indianjpain.org DOI: 10.4103/0970-5333.128893 ABSTRACT This is a case report of a patient (man, 65 year, 70 kg) with severe abdominal and lower extremity pain. Diagnostic methods including color Doppler ultrasound, computed tomography (CT) with contrast, and CT angiography showed thrombosis in abdominal artery near bifurcation of superior mesenteric artery. His pain did not respond to abdominal thromboembolectomy and intravenous injection of heparin and then opioid and acetaminophen. After continuous infusion of lidocaine and nitroglycerin, pain decrease about 20% and after 48 h, it decreases to 80%. This method may be a good option for pain management of acute ischemic pain due to acute arterial occlusion. Key words: Acute arterial occlusion, lidocaine, nitroglycerin Helen Gharaei, Farnad Imani 1 Department of Anesthesiology and Pain Medicine, Boali Hospital, Tehran Azad University of Medical Science, Tehran, 1 Department of Anesthesiology and Pain, Rasoul-Akram Hospital, Tehran University of Medical Science, Tehran, Iran Case Report The patient was a 65-year-old man and weighted 70 kg. He was urgently hospitalized with symptoms of sudden abdominal pain, severe bilateral lower extremity pain (visual analog scale (VAS) for pain score = 10) [Figure 1] with paresthesia and delirium. In physical examination, the left ankle was pale, cold, and tender with no arterial pulse and was cyanotic, but with normal motor function. In the right lower limb, the distal part was cold and cyanotic, with no pulse and movement. He had a history of chronic obstructive pulmonary disease (COPD) and alcoholism. Diagnostic methods including color Doppler ultrasound, CT with contrast, and CT angiography showed thrombosis in abdominal artery near bifurcation of superior mesenteric artery [Figure 2]. Therefore, emergency ambolectomy was performed. After removal of a 15 cm clot, heparin therapy was started. Echocardiography, perfusion scanning, and electrocardiology were normal. He did not appropriately response to medical therapy including NSAIDs and Case Report Address for correspondence: Dr. Helen Gharaei, Department of Anesthesiology and Pain Medicine, Boali Hospital, Damavand St, Tehran, Iran. E-mail: helengharaee@yahoo.com [Downloaded free from http://www.indianjpain.org on Saturday, March 15, 2014, IP: 37.137.93.104] || Click here to download free Android application for this journal