Ultrasound-Guided Thoracic Paravertebral Block as a Sympathetic Blockade for Upper Extremity Neuropathic Pain: A Prospective Pilot Study

Jeongsoo Kim, Ho-Jin Lee, Young-Ju Lee, Chang-Soon Lee, Yongjae Yoo, Jee Youn Moon, Jeongsoo Kim, Ho-Jin Lee, Young-Ju Lee, Chang-Soon Lee, Yongjae Yoo, Jee Youn Moon

Abstract

Purpose: Ultrasound-guided thoracic paravertebral block (US-TPVB) is considered a treatment option for the management of acute pain in various pain-related conditions. We conducted a prospective pilot study to evaluate the possibility of US-TPVB as a sympathetic blockade in patients with neuropathic pain disorders in the upper extremities.

Patients and methods: A total of 12 patients underwent US-TPVB between the T2 and T3 paravertebral space with 10 mL of 1% mepivacaine. The temperature change (°C) before and after the procedure was compared between the ipsilateral and contralateral hands. We counted the proportion of patients showing a temperature increase ≥1.5°C and compared a change in the pain intensity before and after the procedure.

Results: The median increase in the temperature change between the ipsilateral and contralateral hands was 1.54°C (interquartile range, 1.28-2.20). There were seven patients (58.3%) who showed a temperature difference ≥1.5°C between both hands after the US-TPVB. Eleven patients (91.7%) reported a reduction in pain according to the score on the 11-point numerical rating scale. No serious complications relevant to the procedure were reported.

Conclusion: US-TPVB could be a useful technique for sympathetic blockade in patients with upper extremity pain.

Keywords: neuropathic pain; paravertebral block; sympathetic block; ultrasound; upper extremity.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2020 Kim et al.

Figures

Figure 1
Figure 1
Ultrasound-guided thoracic paravertebral block in a sagittal image. Ultrasound image (A) and schematic image (B) are shown.
Figure 2
Figure 2
The difference of temperature change between the ipsilateral and contralateral hands at 20 minutes after the ultrasound-guided thoracic paravertebral block.
Figure 3
Figure 3
Flow diagram of included previous studies.
Figure 4
Figure 4
Schematic axial image of the thoracic paravertebral space.

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