A stellate ganglion block for a patient with complex regional pain syndrome Type i following a transient ischemic attack
Meselhy E, Loomba V, Upadhyay A. A stellate ganglion block for a patient with complex regional pain syndrome Type i following a transient ischemic attack. Regional Anesthesia and Pain Medicine 2017; 42(6).
Regional Anesthesia and Pain Medicine
Introduction The most common inciting events leading to Complex Regional Pain Syndrome (CRPS) are fractures, crush injuries, sprains and surgery. Various other precipitants including crush, stroke and contusion were described. However, no precipitating factors are identified in 0 to 10% of patients (1). Results/Case report A 77 year old male presented with a left wrist and left hand pain of 10 months duration. The pain started few weeks after a transient ischemic attack with left shoulder pain radiating to the left wrist and hand. The pain became more progressive and worse in the wrist and hand. It was described as severe sharp burning pain, that was associated with marked swelling of the wrist as well as temperature, color and trophic changes. There was no improvement despite intensive medical and physical therapy. Clinical presentation was suggestive of Complex Regional Pain Syndrome, Type I. A stellate ganglion block was performed with local anesthetic and steroid mixture providing significant pain relief with more than 80% improvement of pain score and marked improvement of the wrist swelling. Discussion We describe an atypical clinical presentation of Complex Regional Pain Syndrome after a transient ischemic attack that improved significantly after a stellate ganglion block.