A high thoracic erector spinae plane block used for sympathetic block in patients with upper extremity complex regional pain syndrome

2020 ◽  
Vol 60 ◽  
pp. 99-100 ◽  
Author(s):  
Seunguk Bang ◽  
Jaeho Choi ◽  
Eung Don Kim
2019 ◽  
Vol 37 (4) ◽  
pp. 796.e3-796.e4 ◽  
Author(s):  
Abdelghafour Elkoundi ◽  
Zakarya Eloukkal ◽  
Mustapha Bensghir ◽  
Lahcen Belyamani

2019 ◽  
Vol 5 (22;5) ◽  
pp. E417-E424
Author(s):  
Eung Don Kim

Background: Sympathetic block is commonly performed in clinical practice for management of intractable pain conditions. However, stellate ganglion block (SGB) alone often does not achieve sufficient sympatholysis of the upper extremity. The paravertebral space continues up to the cervical sympathetic chain and includes the stellate ganglion. We compared the sympatholytic and analgesic effect of paravertebral block performed at the T2 level (T2 PVB) with that of SGB in patients with complex regional pain syndrome (CRPS) of the upper extremity. Objectives: The aim of this study was to compare the sympatholytic property of T2 PVB with that of the conventional SGB in patients with CRPS of the upper extremity. Study Design: Prospective, randomized cross-over trial. Setting: University hospital pain center in Korea. Methods: Fifteen patients with upper extremity CRPS were randomly assigned to 1 of 2 intervention methods (SGB or T2 PVB). After effects of the first block receded, the patients were crossed over to the second procedure. A difference in temperature increase between the treated side and the opposite side (ΔT) ≥ 1.5°C was considered as a successful primary outcome. Rate of successful primary outcome, degree of pain reduction, duration of effect, and patient satisfaction scores were compared between the 2 intervention methods. Results: Rate of successful primary outcome (ΔT ≥ 1.5°C) was significantly higher in the T2 PVB cases than in the SGB cases (80.0% vs. 20.0%; P = 0.003). Numeric Rating Scale scores after the procedure were significantly lower in the T2 PVB group. Patient satisfaction scores were significantly higher, and the duration of the block was significantly longer in the T2 PVB cases than in the SGB cases. Limitations: The relatively small sample size from a single center, and the lack of standardization of the injected volume of T2 PVB and SGB were limitations. Conclusions: T2 PVB showed superior sympatholytic effect than SGB; other clinical outcomes were also better with T2 PVB than with SGB. T2 PVB can be a useful option for producing sympatholytic and analgesic effect in patients with CRPS of the upper extremity. Key words: Sympathetic block, Complex Regional Pain Syndrome, paravertebral block, stellate ganglion block


2018 ◽  
Vol 19 (2) ◽  
pp. 152
Author(s):  
Pupree Mutsuddy ◽  
Shamim MF Begum ◽  
Rahima Perveen ◽  
Mohammad Simoon Salekin

<p>Asymmetrical uptake of 99m Tc MDP (methylene diphosphonate) in skeletal scintigraphy in extremity may lead to confusion in the diagnosis of metastasis or complex regional pain syndrome. After the exclusion of possible contamination in this report a case was presented with asymmetrical uptake of MDP in the upper extremity from accidental intra-arterial injection.</p><p>Bangladesh J. Nuclear Med. 19(2): 152-154, July 2016</p>


2014 ◽  
Vol 2;17 (2;3) ◽  
pp. 179-185 ◽  
Author(s):  
Nilgun Simsir Atalay

Background: Although there are several studies of systemic corticosteroid therapies in various doses and various durations in complex regional pain syndrome (CRPS), the outcome measurement parameters are limited to the range of motion measurements, edema, and symptoms of CRPS. Objective: To investigate the effects of prednisolone on clinical symptoms, pain, hand grip strength, range of motion, as well as on functional ability and quality of life in patients who developed CRPS after traumatic upper extremity injury. Study Design: Retrospective evaluation. Methods: Forty-five patients who used prednisolone for CRPS of the upper extremity were retrospectively studied. Prednisolone was started with a dose of 30 mg and tapered by 5 mg every 3 days until discontinuation after 3 weeks. Clinical symptoms (morning stiffness, cold intolerance, shoulder pain, numbness of fingers, hyperesthesia, abnormal sweating, and cyanosis that is exacerbated by exposure to cold temperature), pain (Visual Analogue Scale-Rest [VAS-R] and VASActivity [VAS-A]) were reviewed. The muscle strength with grip strength (GS) (kg), lateral pinch (LP) (pound), tip-to-tip pinch (TP) (pound), and chuck pinch (CP) (pound) measurements; the joint range of motion with using third finger tip-distal crease distance (FT-DC) (cm); functional ability with Quick-Disabilities of the Arm, Shoulder and Hand (Q-DASH) score; and quality of life with Short Form-36 (SF-36) score were evaluated. Results: Mean age was 43.53 ± 11.43 years. After 3 weeks of therapy, patients showed significant improvements in clinical symptoms compared to the basal assessments (P < 0.05). The comparison of pre- and post-treatment results revealed that VAS-R, VAS-A, GS, LP, TP, CP, FT-DC, Q-DASH scores, and all SF-36 subscores were significantly improved (P < 0.05). Limitations: The retrospective design and data collection procedure was limited to the medical records of patients. Conclusion: A short-term oral prednisolone therapy significantly reduced the symptoms and signs of CRPS, and improved the functional abilities and quality of life. Key words: Complex regional pain syndrome, prednisolone, function, quality of life


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