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; Debesh Bhoi; Heena Garg; Maya Dehran; Anjan Trikha; Mohammed Tahir Ansari

doi:10.3344/kjp.22299

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자료유형: 학술저널

저자정보: Sreyashi Naskar (All India Institute of Medical Sciences) Debesh Bhoi (All India Institute of Medical Sciences) Heena Garg (All India Institute of Medical Sciences) Maya Dehran (All India Institute of Medical Sciences) Anjan Trikha (All India Institute of Medical Sciences) Mohammed Tahir Ansari (All India Institute of Medical Sciences)

저널정보: 대한통증학회 The Korean Journal of Pain The Korean Journal of Pain 제36권 제2호

발행연도: 2023.4

수록면: 216 - 229 (14page)

DOI: 10.3344/kjp.22299

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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.

#Chronic Pain #Clonidine #Complex Regional Pain Syndromes #Methylprednisolone #Nerve Block #Ropivacaine #Stellate Ganglion #Steroids #Ultrasonography #Interventional.

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