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
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
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 μg) 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.
Abstract
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 μg) 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.
참고문헌 (25)
- Bruehl S, "An update on the pathophysiology of complex regional pain syndrome", Anesthesiology, 113, pp.713~725 (2010)
- Schwartzman RJ, "Reflex sympathetic dystrophy. A review", Arch Neurol, 44, pp.555~561 (1987)
- van Eijs F, "Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome", Pain Pract, 11, pp.70~87 (2011)
- Brummett CM, "Additives to local anesthetics for peripheral nerve blockade", Int Anesthesiol Clin, 49, pp.104~116 (2011)
- Pöpping DM, "Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks : a meta-analysis of randomized trials", Anesthesiology, 111, pp.406~415 (2009)
- Sanjay Vasant Kamble, "Low doses of amitriptyline, pregabalin, and gabapentin are preferred for management of neuropathic pain in India: is there a need for revisiting dosing recommendations?", The Korean Journal of Pain, 30(3), pp.183~191 (2017), 대한통증학회
- Kapral S, "Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study", Reg Anesth, 20, pp.323~328 (1995)
- Matsumoto S, "Thermographic assessments of the sympathetic blockade by stellate ganglion block (1)comparison between C7-SGB and C6-SGB in 40 patients", Masui, 40, pp.562~569 (1991)
- 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, 40, pp.692~701 (1991)
- Malmqvist EL, "Efficacy of stellate ganglion block : a clinical study with bupivacaine", Reg Anesth, 17, pp.340~347 (1992)
- Jadon A, "Revalidation of a modified and safe approach of stellate ganglion block", Indian J Anaesth, 55, pp.52~56 (2011)
- Elias M, "Cervical sympathetic and stellate ganglion blocks", Pain Physician, 3, pp.294~304 (2000)
- Evans JA, "Sympathectomy for reflex sympathetic dystrophy; report of twenty-nine cases", J Am Med Assoc, 132, pp.620~623 (1946)
- Yucel I, "Complex regional pain syndrome type I : efficacy of stellate ganglion blockade", J Orthop Traumatol, 10, pp.179~183 (2009)
- McCartney CJ, "Should we add clonidine to local anesthetic for peripheral nerve blockade? A qualitative systematic review of the literature", Reg Anesth Pain Med, 32, pp.330~338 (2007)
- Dalle C, "Inhibition of the I(h) current in isolated peripheral nerve: a novel mode of peripheral antinociception?", Muscle Nerve, 24, pp.254~261 (2001)
- Leem JW, "Conduction block by clonidine is not mediated by alpha2-adrenergic receptors in rat sciatic nerve fibers", Reg Anesth Pain Med, 25, pp.620~625 (2000)
- Gaumann DM, "Hyperpolarizing afterpotentials in C fibers and local anesthetic effects of clonidine and lidocaine", Pharmacology, 48, pp.21~29 (1994)
- Nascimento MS, "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, 43, pp.1239~1244 (2010)
- 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, 63, pp.851~855 (2019)
- Datta R, "A study of the efficacy of stellate ganglion blocks in complex regional pain syndromes of the upper body", J Anaesthesiol Clin Pharmacol, 33, pp.534~540 (2017)
- Makharita MY, "Effect of early stellate ganglion blockade for facial pain from acute herpes zoster and incidence of postherpetic neuralgia", Pain Physician, 15, pp.467~474 (2012)
- Eker HE, "Management of neuropathic pain with methylprednisolone at the site of nerve injury", Pain Med, 13, pp.443~451 (2012)
- Klein DS, "Low-volume ulnar nerve block within the axillary sheath for the treatment of reflex sympathetic dystrophy", Can J Anaesth, 38, pp.764~766 (1991)
- Hakim KYK, "Clonidine in lumbar sympathetic block for lower limb complex regional pain syndrome", Ain-Shams J Anaesthesiol, 7, pp.320~326 (2014)