Affiliation:
1. Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India
2. Department of Paediatrics, Subunit of Paediatric Rheumatology, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India
Abstract
Abstract
Objective
Sympathetic blocks are invaluable to prevent morbidity from Raynaud’s phenomenon (RP). RP may occur in children with rheumatological disorders and causes severe pain, discoloration of digits, gangrene, and auto-amputation. We describe the planning and execution of sympathectomy blocks in children with rheumatological disorders presenting with RP.
Methods
With upper-limb involvement, ultrasound-guided stellate ganglion block (USGB) was given with ropivacaine and clonidine. When all four limbs were involved, intrathecal block with bupivacaine and clonidine was also given.
Results
A total of 68 sympathectomy blocks were performed: 28 bilateral USGBs, two unilateral USGBs, and 10 intrathecal injections. Multiple interventions in a single day were frequently required. For safety, all USGBs were performed with an ultrasound with strict adherence to local anaesthetic volume was maintained, with periprocedure monitoring of 2–3 hours. All blocks were performed by an experienced specialist. All children reported immediate pain relief with prevention of major amputation.
Conclusion
With meticulous planning, monitoring, and precautions, sympathectomy of limbs in pediatric rheumatological disorders with RP can be safely undertaken. Bilateral stellate ganglion block with ultrasound is safe in children, and clonidine is a useful adjunct for vasodilation and prolongation of the effect of sympathectomies in children.
Publisher
Oxford University Press (OUP)
Subject
Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine
Cited by
2 articles.
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