title: Stellate ganglion blockade (SGB) for refractory index finger pain - a case report.
abstract: OBJECTIVE
  To identify through case study the presentation and possible pathophysiological cause of complex regional pain syndrome and its preferential response to stellate ganglion blockade.
  
  
  METHODS
  Complex regional pain syndrome can occur in an extremity after minor injury, fracture, surgery, peripheral nerve insult or spontaneously and is characterised by spontaneous pain, changes in skin temperature and colour, oedema, and motor disturbances. Pathophysiology is likely to involve peripheral and central components and neurological and inflammatory elements. There is no consistent approach to treatment with a wide variety of specialists involved. Diagnosis can be difficult, with over-diagnosis resulting from undue emphasis placed upon pain disproportionate to an inciting event despite the absence of other symptoms or under-diagnosed when subtle symptoms are not recognised. The International Association for the Study of Pain supports the use of sympathetic blocks to reduce sympathetic nervous system overactivity and relieve complex regional pain symptoms. Educational reviews promote stellate ganglion blockade as beneficial. Three blocks were given at 8, 10 and 13 months after the initial injury under local anaesthesia and sterile conditions. Physiotherapeutic input was delivered under block conditions to maximise joint and tissue mobility and facilitate restoration of function.
  
  
  CONCLUSIONS
  This case demonstrates the need for practitioners from all disciplines to be able to identify the clinical characteristics of complex regional pain syndrome to instigate immediate treatment and supports the notion that stellate ganglion blockade is preferable to upper limb intravenous regional anaesthetic block for refractory index finger pain associated with complex regional pain syndrome.
authors.affiliation: Pain Management Services, Mid Yorkshire Hospitals NHS Trust, The Boothroyd Day Centre, Dewsbury & District Hospital, Dewsbury, WF13 4HS, West Yorkshire, United Kingdom. martin.hey@midyorks.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Hey
authors.forename: I
authors.initials: I
authors.lastname: Wilson
authors.forename: M I
authors.initials: MI
authors.lastname: Johnson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000058:Accidental Falls; D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000588:Amines / Q000627:therapeutic use; D001340:Autonomic Nerve Block; D002908:Chronic Disease; D003061:Codeine / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004414:Dyspareunia / Q000209:etiology; D004487:Edema / Q000209:etiology; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D005383:Finger Injuries / Q000628:therapy*; D005385:Fingers / Q000294:innervation; D000077206:Gabapentin; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D009020:Morphine / Q000627:therapeutic use; D012019:Reflex Sympathetic Dystrophy / Q000209:etiology / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000188:drug therapy / Q000628:therapy; D013233:Stellate Ganglion / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000293:injuries; D016055:Urinary Retention / Q000209:etiology; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine; D003061:Codeine