The Korean Journal of Pain

  • 제36권2호
  • /
  • Pages.216-229
  • /
  • 2023
  • /
  • 2005-9159(pISSN)
  • /
  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
권호 표지
DOI QR코드

DOI QR Code

A comparison of analgesic efficacy and safety of clonidine and methylprednisolone as additives to 0.25% ropivacaine in stellate ganglion block for the treatment of complex regional pain syndrome: a prospective randomised single blind study

  • Sreyashi Naskar (Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences) ;
  • Debesh Bhoi (Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences) ;
  • Heena Garg (Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences) ;
  • Maya Dehran (Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences) ;
  • Anjan Trikha (Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences) ;
  • Mohammed Tahir Ansari (Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences)
  • 투고 : 2022.08.24
  • 심사 : 2023.01.26
  • 발행 : 2023.04.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: The role of the sympathetic nervous system appears to be central in causing pain in complex regional pain syndrome (CRPS). The stellate ganglion block (SGB) using additives with local anesthetics is an established treatment modality. However, literature is sparse in support of selective benefits of different additives for SGB. Hence, the authors aimed to compare the efficacy and safety of clonidine with methylprednisolone as additives to ropivacaine in the SGB for treatment of CRPS. Methods: A prospective randomized single blinded study (the investigator blinded to the study groups) was conducted among patients with CRPS-I of the upper limb, aged 18-70 years with American Society of Anaesthesiologists physical status I-III. Clonidine (15 ㎍) and methylprednisolone (40 mg) were compared as additives to 0.25% ropivacaine (5 mL) for SGB. After medical treatment for two weeks, patients in each of the two groups were given seven ultrasound guided SGBs on alternate days. Results: There was no significant difference between the two groups with respect to visual analogue scale score, edema, or overall patient satisfaction. After 1.5 months follow-up, however, the group that received methylprednisolone had better improvement in range of motion. No significant side effects were seen with either drug. Conclusions: The use of additives, both methylprednisolone and clonidine, is safe and effective for the SGB in CRPS. The significantly better improvement in joint mobility with methylprednisolone suggests that it should be considered promising as an additive to local anaesthetics when joint mobility is the concern.

키워드

참고문헌

  1. Bruehl S. An update on the pathophysiology of complex regional pain syndrome. Anesthesiology 2010; 113: 713-25. https://doi.org/10.1097/ALN.0b013e3181e3db38
  2. Schwartzman RJ, McLellan TL. Reflex sympathetic dystrophy. A review. Arch Neurol 1987; 44: 555-61. https://doi.org/10.1001/archneur.1987.00520170081028
  3. van Eijs F, Stanton-Hicks M, Van Zundert J, Faber CG, Lubenow TR, Mekhail N, et al. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome. Pain Pract 2011; 11: 70-87. https://doi.org/10.1111/j.1533-2500.2010.00388.x
  4. Brummett CM, Williams BA. Additives to local anesthetics for peripheral nerve blockade. Int Anesthesiol Clin 2011; 49: 104-16. https://doi.org/10.1097/AIA.0b013e31820e4a49
  5. Popping DM, Elia N, Marret E, Wenk M, Tramer MR. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. Anesthesiology 2009; 111: 406-15. https://doi.org/10.1097/ALN.0b013e3181aae897
  6. Kamble SV, Motlekar SA, D'souza LL, Kudrigikar VN, Rao SE. Low doses of amitriptyline, pregabalin, and gabapentin are preferred for management of neuropathic pain in India: is there a need for revisiting dosing recommendations? Korean J Pain 2017; 30: 183-91. https://doi.org/10.3344/kjp.2017.30.3.183
  7. Kapral S, Krafft P, Gosch M, Fleischmann D, Weinstabl C. Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study. Reg Anesth 1995; 20: 323-8.
  8. Matsumoto S. [Thermographic assessments of the sympathetic blockade by stellate ganglion block (1) comparison between C7-SGB and C6-SGB in 40 patients]. Masui 1991; 40: 562-9. Japanese.
  9. Matsumoto S. [Thermographic assessments of the sympathetic blockade by stellate ganglion block (2)--comparison and analysis of thermographic patterns between C7-SGB and C6-SGB in 20 healthy volunteers]. Masui 1991; 40: 692-701. Japanese.
  10. Malmqvist EL, Bengtsson M, Sorensen J. Efficacy of stellate ganglion block: a clinical study with bupivacaine. Reg Anesth 1992; 17: 340-7.
  11. Jadon A. Revalidation of a modified and safe approach of stellate ganglion block. Indian J Anaesth 2011; 55: 52-6. https://doi.org/10.4103/0019-5049.76601
  12. Elias M. Cervical sympathetic and stellate ganglion blocks. Pain Physician 2000; 3: 294-304. https://doi.org/10.36076/ppj.2000/3/294
  13. Evans JA. Sympathectomy for reflex sympathetic dystrophy; report of twenty-nine cases. J Am Med Assoc 1946; 132: 620-3.
  14. Yucel I, Demiraran Y, Ozturan K, Degirmenci E. Complex regional pain syndrome type I: efficacy of stellate ganglion blockade. J Orthop Traumatol 2009; 10: 179-83. https://doi.org/10.1007/s10195-009-0071-5
  15. McCartney CJ, Duggan E, Apatu E. Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature. Reg Anesth Pain Med 2007; 32: 330-8. https://doi.org/10.1097/00115550-200707000-00010
  16. Dalle C, Schneider M, Clergue F, Bretton C, Jirounek P. Inhibition of the I(h) current in isolated peripheral nerve: a novel mode of peripheral antinociception? Muscle Nerve 2001; 24: 254-61. https://doi.org/10.1002/1097-4598(200102)24:2<254::AID-MUS110>3.0.CO;2-#
  17. Leem JW, Choi Y, Han SM, Yoon MJ, Sim JY, Leem SW. Conduction block by clonidine is not mediated by alpha2-adrenergic receptors in rat sciatic nerve fibers. Reg Anesth Pain Med 2000; 25: 620-5. https://doi.org/10.1053/rapm.2000.16160
  18. Gaumann DM, Brunet PC, Jirounek P. Hyperpolarizing afterpotentials in C fibers and local anesthetic effects of clonidine and lidocaine. Pharmacology 1994; 48: 21-9. https://doi.org/10.1159/000139158
  19. Nascimento MS, Klamt JG, Prado WA. Intravenous regional block is similar to sympathetic ganglion block for pain management in patients with complex regional pain syndrome type I. Braz J Med Biol Res 2010; 43: 1239-44. https://doi.org/10.1590/S0100-879X2010007500123
  20. Punj J. Multiple bilateral ultrasound-guided stellate ganglion blocks to treat acute vasculitis in a recently diagnosed patient of systemic lupus erythematosus. Indian J Anaesth 2019; 63: 851-5. https://doi.org/10.4103/ija.IJA_331_19
  21. Datta R, Agrawal J, Sharma A, Rathore VS, Datta S. A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body. J Anaesthesiol Clin Pharmacol 2017; 33: 534-40. https://doi.org/10.4103/joacp.JOACP_326_16
  22. Makharita MY, Amr YM, El-Bayoumy Y. Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia. Pain Physician 2012; 15: 467-74.
  23. Eker HE, Cok OY, Aribogan A, Arslan G. Management of neuropathic pain with methylprednisolone at the site of nerve injury. Pain Med 2012; 13: 443-51. https://doi.org/10.1111/j.1526-4637.2011.01323.x
  24. Klein DS, Klein PW. Low-volume ulnar nerve block within the axillary sheath for the treatment of reflex sympathetic dystrophy. Can J Anaesth 1991; 38: 764-6. https://doi.org/10.1007/BF03008456
  25. Hakim KYK, Abd El Fatah AM. Clonidine in lumbar sympathetic block for lower limb complex regional pain syndrome. Ain-Shams J Anaesthesiol 2014; 7: 320-6. https://doi.org/10.4103/1687-7934.139557