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THORACIC SYMPATHETIC BLOCK WITH BOTULINUM TOXIN TYPE B FOR A PATIENT WITH MEDIAN NERVE INJURY: A CASE STUDY
ESRA Academy. Yoo D. Sep 9, 2016; 138309; 0137 Topic: REGIONAL ANAESTHESIA TECHNIQUES - BLOCK PERFORMANCE
Dr. Da Hye Yoo
Dr. Da Hye Yoo

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Abstract
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Background and Aims:

Thoracic sympathetic block is an effective method for relief of sympathetically mediated pain in the upper extremities. In order to prolong the sympathetic blockade, sympathetic destruction with alcohol or radiofrequency has been used. Yet, there are no reports on the use of botulinum and its efficacy as the neurolytic adjuvant for thoracic sympathetic ganglion neruolysis procedure. In this report, we present our experience of dorsal percutaneous thoracic sympathetic ganglion neurolysis using botulinum toxin B for treating neuropathy.

Methods:

A 54 year old woman was referred to our pain clinic due to persistent pain and motor weakness of the left arm after undergoing median nerve graft operation 7 months ago. The pain intensity was 9/10 at rest on the visual analog scale  score and the Leeds assessment of neuropathic symptoms and signs score was 24/24. The patient reported persistent pain with allodynia, hyperalgesia, involuntary tremor along with motor weakness. After a success of the thoracic sympathetic ganglion with local anesthetics, we performed thoracic sympathetic ganglion neurolysis under fluoroscopic guidance using Botulinum type B at the T2 and T3 sympathetic ganglia. 0.25% levobupivacaine 5mL mixed with BTX-B 2500 IU was administered.

Results:

Two months after TSB with BTX-B, pain intensity and the Leeds assessment of neuropathic symptoms and signs score were significantly reduced. Allodynia and coldness disappeared and skin color of the patients came back to normal.

Conclusions:

In conclusion, BTX-B can produce efficacious and durable sympathetic blocking effect on patients with peripheral nerve injury.

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