title: Lumbar Sympathetic Block with Botulinum Toxin Type B for Complex Regional Pain Syndrome: A Case Study.
abstract: Lumbar sympathetic block (LSB) is an effective method for relief of sympathetically mediated pain in the lower extremities. To prolong the sympathetic blockade, sympathetic destruction with alcohol or radiofrequency has been used. The pre-ganglionic sympathetic nerves are cholinergic, and botulinum toxin (BTX) has been found to inhibit the release of acetylcholine at the cholinergic nerve terminals. Moreover, BTX type B (BTX-B) is more convenient to use than BTX type A. Based on these findings, we performed LSB on the 2 patients with complex regional pain syndrome (CRPS) in the lower extremity. Levobupivacaine 0.25% 5 mL mixed with BTX-B 5,000 IU was given under fluoroscopic guidance. Two months after LSB with BTX-B, pain intensity and the Leeds assessment of neuropathic symptoms and signs (LANSS) score were significantly reduced. Allodynia and coldness disappeared and skin color came back to normal. In conclusion, BTX-B can produce an efficacious and durable sympathetic blocking effect on patients with CRPS.
authors.forename: Eunjoo
authors.initials: E
authors.lastname: Choi
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Chan Woo
authors.initials: CW
authors.lastname: Cho
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Pyung Bok
authors.initials: PB
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Francis Sahngun
authors.initials: FS
authors.lastname: Nahm
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000842:Ankle; D001340:Autonomic Nerve Block / Q000379:methods*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D020918:Complex Regional Pain Syndromes / Q000188:drug therapy*; D006801:Humans; D006930:Hyperalgesia / Q000188:drug therapy / Q000209:etiology; D007866:Leg; D000077554:Levobupivacaine; D035002:Lower Extremity; D008297:Male; D009437:Neuralgia / Q000188:drug therapy; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D012880:Skin Pigmentation / Q000187:drug effects; D013563:Sympathectomy, Chemical / Q000379:methods*; D013565:Sympatholytics / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D009465:Neuromuscular Agents; D013565:Sympatholytics; D000077554:Levobupivacaine; D019274:Botulinum Toxins, Type A; D002045:Bupivacaine