Open AccessA Prospective, Randomized Cross-Over Trial of T2 Paravertebral Block as a Sympathetic Block in Complex Regional Pain Syndrome
Author(s) -
Young Hoon Kim,
Seo Yeong Kim,
Yun Jae Lee,
Eung Don Kim
Publication year - 2019
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj/2019.22.e417
Subject(s) - medicine , complex regional pain syndrome , anesthesia , patient satisfaction , stellate ganglion , randomized controlled trial , prospective cohort study , analgesic , surgery , physical therapy , alternative medicine , pathology
Background: Sympathetic block is commonly performed in clinical practice for managementof intractable pain conditions. However, stellate ganglion block (SGB) alone often does notachieve sufficient sympatholysis of the upper extremity. The paravertebral space continuesup to the cervical sympathetic chain and includes the stellate ganglion. We compared thesympatholytic 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 withthat 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 2intervention methods (SGB or T2 PVB). After effects of the first block receded, the patientswere crossed over to the second procedure. A difference in temperature increase betweenthe treated side and the opposite side (ΔT) ≥ 1.5°C was considered as a successful primaryoutcome. 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 T2PVB cases than in the SGB cases (80.0% vs. 20.0%; P = 0.003). Numeric Rating Scale scoresafter the procedure were significantly lower in the T2 PVB group. Patient satisfaction scoreswere significantly higher, and the duration of the block was significantly longer in the T2 PVBcases than in the SGB cases.Limitations: The relatively small sample size from a single center, and the lack ofstandardization of the injected volume of T2 PVB and SGB were limitations.Conclusions: T2 PVB showed superior sympatholytic effect than SGB; other clinical outcomeswere also better with T2 PVB than with SGB. T2 PVB can be a useful option for producingsympatholytic and analgesic effect in patients with CRPS of the upper extremity.Key words: Sympathetic block, Complex Regional Pain Syndrome, paravertebral block,stellate ganglion block