Ultrasound-Guided Stellate Ganglion and Interscalene Blocks for Refractory Pediatric Parsonage-Turner Syndrome: A
Warda Laraib1, Adeel Abbas2, Insha Habib1
1Al-Nafees Medical College, Islamabad, Pakistan.
Background:
Parsonage-Turner syndrome (PTS) is an uncommon inflammatory brachial plexopathy; pediatric and bilateral cases are rare, and evidence for managing refractory pediatric pain is limited.
Case Report:
A previously healthy 6-year-old girl developed sudden severe left upper-limb pain with progressive wrist-drop in August 2023; by October, the right arm was affected. Nerve conduction studies/electromyography confirmed brachial plexopathy and magnetic resonance imaging showed diffuse thickening of left C5-C7. Laboratory tests were unremarkable, except for an isolated anti-glycosphingolipid monosialo-2 antibody. Oral corticosteroids, tramadol, and 2 intravenous immunoglobulin doses produced limited benefit, and corticosteroids caused mood disturbance. In October 2023, ultrasound-guided stellate ganglion (C6) and interscalene (C5-C6) blocks with 4-6 mL of 0.25% bupivacaine under general anesthesia were performed. At one week, she reported ~85% pain relief; analgesics were reduced to paracetamol.
Conclusions:
In refractory pediatric bilateral PTS, regional stellate ganglion and interscalene blocks provided rapid, substantial analgesia; prospective studies should define indications and long-term outcomes.
