Korean J Pain.  2023 Apr;36(2):216-229. 10.3344/kjp.22299.

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

• Naskar S
• Bhoi D
• Garg H
• Dehran M
• Trikha A
• Ansari MT

• KMID: 2541030
• DOI: http://doi.org/10.3344/kjp.22299

Abstract

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.

Keyword

Chronic Pain; Clonidine; Complex Regional Pain Syndromes; Methylprednisolone; Nerve Block; Ropivacaine; Stellate Ganglion; Steroids; Ultrasonography, Interventional

Figure

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  Fig. 1 CONSORT diagram.

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  Fig. 2 USG image showing sonoanatomy of SGB. USG: ultrasonography, SGB: stellate ganglion block, SCM: sternocleidomastoid muscle, CA: internal carotid artery, IJV: internal jugular vein, PVF: prevertebral fascia, LC: longus coli muscle, T: transverse process of C6 vertebra.

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  Fig. 3 Colour Doppler mode used to detect blood vessels in the vicinity.

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  Fig. 4 Needle path in real time imaging. A: carotid artery, B: internal jugular vein, C: needle piercing the fascia covering longus colli, D: transverse process of C7, E: longus colli.

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  Fig. 5 Edema score at the wrist joint. Group C: subjects who were given clonidine as additive in stellate ganglion block (SGB), Group D: subjects who were given methylprednisolone as additive in SGB.

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  Fig. 6 Mean Quick DASH scores. DASH: Disabilities of Arm, Shoulder and Hand. Group C: subjects who were given clonidine as additive in stellate ganglion block (SGB). Group D: subjects who were given methylprednisolone as additive in SGB.

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  Fig. 7 Mean BPI scores. BPI: Brief Pain Inventory. Group C: subjects who were given clonidine as additive in stellate ganglion block (SGB). Group D: subjects who were given methylprednisolone as additive in SGB.

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  Fig. 8 Mean patient satisfaction scores. Group C: subjects who were given clonidine as additive in stellate ganglion block (SGB). Group D: subjects who were given methylprednisolone as additive in SGB.

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