게시판
| 21KS-030 |
A Randomized Double-blinded Controlled Study of Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex
1Department
of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul,
Republic of Korea,
Background: Sympathetic block is a widely used treatment option for various pain disorders. However, there is low-level evidence regarding the use of botulinum toxin for the sympathetic block in pain management. This randomized, double-blinded, comparative study aimed to investigate the efficacy of botulinum toxin type A for lumbar sympathetic ganglion block in patients with complex regional pain syndrome.
Methods: We assessed patients with lower-extremity complex regional pain syndrome who underwent lumbar sympathetic ganglion block using 75 IU of botulinum toxin type A (BTX group) or only local anesthetics (Control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as changes in pain intensity, cold intolerance, and popliteal arterial velocity.
Results: From April 2019 to November 2020, 64 participants were screened; among them, 48 participants (N = 24 per group) were randomly assigned. The change in relative temperature increase was much higher in the BTX group (1.0°C ± 1.3; 95% CI: 0.4 (0.1°C ± 0.8; 95% CI: -0.3hich was maintained at 3 months (adjusted P = 0.01). Moreover, pain intensity and cold intolerance were improved in the BTX group compared with the Control group within the 3-month follow-up period (P < 0.01 and P < 0.001, respectively). There were no between-group differences in popliteal arterial velocities. There were no severe adverse events related to botulinum toxin injection during the study.
Conclusion: Compared to local anesthetics only, botulinum toxin type A injection into lumbar sympathetic ganglia increased the temperature of the affected foot for 3 months, which was followed by pain reduction and cold intolerance improvement in the complex regional pain syndrome.
1. Attal N, De Andrade DC, Adam F, Ranoux D, Teixeira MJ, Galhardoni R, Raicher I, C, Bouhassira D: Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2016;15:555-65.
2. Dev S, Yoo Y, Lee H-J, Kim D-H, Kim Y-C, Moon JY: Does temperature increase by sympathetic neurolysis improve pain in complex regional pain syndrome. A retrospective cohort study. World Neurosurg 2018;109:e783
Methods: We assessed patients with lower-extremity complex regional pain syndrome who underwent lumbar sympathetic ganglion block using 75 IU of botulinum toxin type A (BTX group) or only local anesthetics (Control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as changes in pain intensity, cold intolerance, and popliteal arterial velocity.
Results: From April 2019 to November 2020, 64 participants were screened; among them, 48 participants (N = 24 per group) were randomly assigned. The change in relative temperature increase was much higher in the BTX group (1.0°C ± 1.3; 95% CI: 0.4 (0.1°C ± 0.8; 95% CI: -0.3hich was maintained at 3 months (adjusted P = 0.01). Moreover, pain intensity and cold intolerance were improved in the BTX group compared with the Control group within the 3-month follow-up period (P < 0.01 and P < 0.001, respectively). There were no between-group differences in popliteal arterial velocities. There were no severe adverse events related to botulinum toxin injection during the study.
Conclusion: Compared to local anesthetics only, botulinum toxin type A injection into lumbar sympathetic ganglia increased the temperature of the affected foot for 3 months, which was followed by pain reduction and cold intolerance improvement in the complex regional pain syndrome.
1. Attal N, De Andrade DC, Adam F, Ranoux D, Teixeira MJ, Galhardoni R, Raicher I, C, Bouhassira D: Safety and efficacy of repeated injections of botulinum toxin A in peripheral neuropathic pain (BOTNEP): a randomised, double-blind, placebo-controlled trial. Lancet Neurol 2016;15:555-65.
2. Dev S, Yoo Y, Lee H-J, Kim D-H, Kim Y-C, Moon JY: Does temperature increase by sympathetic neurolysis improve pain in complex regional pain syndrome. A retrospective cohort study. World Neurosurg 2018;109:e783
