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Two years follow-up of continuous erector spinae plane block in a patient with upper extremity complex regional pain syndrome type I
  1. Mauricio Forero1,
  2. Rami A Kamel1,
  3. Philip Lung Chan1 and
  4. Eugene Maida2
  1. 1Anesthesia, McMaster University Michael G DeGroote School of Medicine, Hamilton, Canada
  2. 2Physical Medicine and Rehabilitation and Anesthesia, McMaster University Michael G DeGroote School of Medicine, Hamilton, Canada
  1. Correspondence to Dr Mauricio Forero, Anesthesia, McMaster University Michael G DeGroote School of Medicine, Hamilton, Canada; Maoforeroman{at}hotmail.com

Abstract

Background Recalcitrant complex regional pain syndrome (CRPS) type 1 is a devastating condition.

Case presentation We report a case of a patient in their twenties with left hand and forearm CRPS type I, transiently responsive to spinal cord stimulation, thoracic sympathectomy, and multimodal analgesia. The investigators initiated a trial of a single-shot erector spinae plane block at the T2 level, resulting in a clinically significant improvement in pain, function, vasomotor and sudomotor symptoms transiently for a 36-hour interval. As a result, a permanent e-port catheter implantation under combined ultrasound and fluoroscopic guidance was trialed. Two-year follow-up of the continuous erector spinae plane block (CESPB) indicated an 80% reduction in pain scores from baseline, and a 50% reduction in opiate consumption, with a clinically significant reduction in swelling, color changes, allodynia, and temperature asymmetry.

Conclusion Recalcitrant CRPS type 1 is a challenging life-altering condition that results in a cyclical triad of chronic pain, disability, and impaired psychosocial health. The profound and prolonged analgesic response to CESPB, highlights the clinical utility of this technique, and warrants more clinical investigation.

  • Complex Regional Pain Syndromes
  • Autonomic Nerve Block
  • CHRONIC PAIN
  • Pain Management
  • Ultrasonography

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Footnotes

  • Twitter @DrRomello

  • Contributors MF: Responsible author, manuscript conceptualization and writing. RAK: Manuscript writing, editing and critical review. PLC: Conduct of interventional procedures, clinical care and follow-up of the patient. EM: Manuscript writing, conduct of interventional procedures.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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