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Abstract
Please confirm that an ethics committee approval has been applied for or granted: Not relevant
Background and Aims Neurolysis with ultrasound-guided Stellate ganglion block (SGB) offers a minimally invasive and targeted approach for managing the symptoms of chronic Raynaud phenomenon (RP) such as digital ischemia and pain.
Methods We were referred a 39 year old female patient with Systemic Sclerosis and developed RP since 8 months, who had necrosis of the first, second and third digits of the right hand with pulsating pins and needles sensation. The pain was especially intense during the night, and did not subside after systemic multimodal analgesia. We performed neurolysis ultrasound-guided SGB. With 1 ml of 1% lidocaine on the surface of longus colli muscle at the level C6, patient confirmed lesser pain sensation. Then we continued to deposit 0.5 ml of 2% lidocaine, 2 ml of 96% alcohol, 0.5 ml of 0.5% bupivacaine and dexametasone 2.5mg on the surface of longus colli muscle at the level C6 and at the level of C7.
Results Significant pain relief accompanied with transient Horner Syndrome on the right side showed within minutes after procedures completion. During the first week patient showed significant pain relief, morphine was tapered off and stopped in first week. After seven days post SGB procedure, patient started to feel the pain again especially at night, although the intensity was still manageable with clonidine and diclofenac.
Ultrasound image of injection
Conclusions The positive outcome of the procedure with significant pain relief and reduced reliance on systemic analgesia, suggests that SGB can be a valuable intervention for chronic intractable RP.