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Sympathetic Blocks for Raynaud's Phenomena in Pediatric Rheumatological Disorders
Jyotsna Punj1, Heena Garg1, Gaurav Gomez1
1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Pain Medicine (Malden, Mass.)
|February 8, 2022
Summary
Sympathetic blocks effectively manage Raynaud
Area of Science:
- Pediatric Rheumatology
- Pain Management
- Interventional Pain Medicine
Background:
- Raynaud's phenomenon (RP) in children with rheumatological disorders can lead to severe pain and digit loss.
- Sympathetic blocks are crucial for preventing morbidity associated with RP.
Purpose of the Study:
- To describe the planning and execution of sympathectomy blocks in pediatric rheumatological patients with RP.
- To evaluate the safety and efficacy of these procedures.
Main Methods:
- Ultrasound-guided stellate ganglion block (USGB) with ropivacaine and clonidine for upper-limb RP.
- Intrathecal block with bupivacaine and clonidine for four-limb involvement.
- Performed 68 blocks (28 bilateral USGBs, 2 unilateral USGBs, 10 intrathecal injections) with strict monitoring.
Main Results:
- All children experienced immediate pain relief.
- Major amputations were prevented in all cases.
- Ultrasound-guided stellate ganglion block (USGB) proved safe and effective.
Conclusions:
- Sympathectomy blocks are safe and effective for pediatric rheumatological disorders with RP when meticulously planned and monitored.
- Ultrasound-guided stellate ganglion block (USGB) is safe in children.
- Clonidine is a beneficial adjunct for vasodilation and prolonging sympathectomy effects.
Keywords:
ChildrenIntrathecalPediatricRaynaud’s PhenomenonRheumatology DisordersStellate Ganglion BlockSympathectomyMore Related Videos
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