The 68th
Scientific Meeting
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| 19S-060 |
Ultrasound-guided cervical sympathetic block with botulinum toxin type-A for pain relief in patient with optic neuritis
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea
Introduction
There are many reports of stellate ganglion blocks with local anesthetics for the treatment of various chronic pain syndromes. However, the stellate ganglion block with local anesthetics has a short duration of effect and the botulinum injection in stellate ganglion for the treatment of ocular pain has never been reported in the previous literature.
We reports a case that describes an effective pain relief and prolongation of the effect when injecting a botulinum toxin type-A into the stellate ganglion to a patient who has a persistent severe eye pain with visual disturbance. But there were unexpected complications such as dysphagia associated with hyperactivity of pharyngeal muscles by injected botulinum toxin spreading to SCM. So, the titration of injecting dose and volume was needed to achieve optimal results without adverse side effects.
Case
A 35 year-old woman who was diagnosed with optic neuritis in multiple sclerosis came to the hospital with severe eye pain. We performed stellate ganglion block using local anesthetics for several times, but pain relief did not last more than one day. We also tried pulsed radiofrequency ablation, but the effect did last for two days. We injected botulinum toxin type-A in stellate ganglion under ultrasound guidance. In spite of improvement in eye pain and prolongation of the duration of pain relief, she complained of swallowing disturbance. The symptoms completely disappeared after one month. Initially, the administrated dose of botulinum toxin was 50-unit diluted with sterile saline, totally 5mL. After a few months, the lower botulinum toxin dose was applied for stellate ganglion block with either 25-unit or 10-unit. The long-lasting analgesic effects were accompanied by swallowing disturbance in a series of three cases. Secondly, the botulinum toxin dose was 10-unit with 0.3mL saline. There were neither effects nor complications. Since then, we have been trying to determine the appropriate dose of botulinum toxin without causing side effects including swallowing problems.
Conclusion
Ultrasound guided stellate ganglion block with botulinum toxin type-A could be one of the options as an analgesic modality in multiple sclerosis-induced optic neuritis. However, It is needed to consider the possibility of side effects due to botulinum injection before implementing the block.
There are many reports of stellate ganglion blocks with local anesthetics for the treatment of various chronic pain syndromes. However, the stellate ganglion block with local anesthetics has a short duration of effect and the botulinum injection in stellate ganglion for the treatment of ocular pain has never been reported in the previous literature.
We reports a case that describes an effective pain relief and prolongation of the effect when injecting a botulinum toxin type-A into the stellate ganglion to a patient who has a persistent severe eye pain with visual disturbance. But there were unexpected complications such as dysphagia associated with hyperactivity of pharyngeal muscles by injected botulinum toxin spreading to SCM. So, the titration of injecting dose and volume was needed to achieve optimal results without adverse side effects.
Case
A 35 year-old woman who was diagnosed with optic neuritis in multiple sclerosis came to the hospital with severe eye pain. We performed stellate ganglion block using local anesthetics for several times, but pain relief did not last more than one day. We also tried pulsed radiofrequency ablation, but the effect did last for two days. We injected botulinum toxin type-A in stellate ganglion under ultrasound guidance. In spite of improvement in eye pain and prolongation of the duration of pain relief, she complained of swallowing disturbance. The symptoms completely disappeared after one month. Initially, the administrated dose of botulinum toxin was 50-unit diluted with sterile saline, totally 5mL. After a few months, the lower botulinum toxin dose was applied for stellate ganglion block with either 25-unit or 10-unit. The long-lasting analgesic effects were accompanied by swallowing disturbance in a series of three cases. Secondly, the botulinum toxin dose was 10-unit with 0.3mL saline. There were neither effects nor complications. Since then, we have been trying to determine the appropriate dose of botulinum toxin without causing side effects including swallowing problems.
Conclusion
Ultrasound guided stellate ganglion block with botulinum toxin type-A could be one of the options as an analgesic modality in multiple sclerosis-induced optic neuritis. However, It is needed to consider the possibility of side effects due to botulinum injection before implementing the block.
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