Lumbar Sympathetic Block to Treat CRPS in an 18-Month-Old Girl: A Breaking Barriers Case Report and Review of Literature.

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL ACS Applied Energy Materials Pub Date : 2024-12-01 Epub Date: 2024-09-05 DOI:10.1007/s40122-024-00650-1

Amany E Ayad, Nora A Agiza, Amr H Elrifay, Ahmed M Mortada, Marian Y Girgis, Giustino Varrassi

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Abstract

Background: Children under the age of 3 years have been diagnosed with complex regional pain syndrome (CRPS). They were found to be functionally disadvantaged and psychologically distressed in relation to children with other painful conditions.

Case presentation: An 18-month-old baby girl was referred to the pain clinic with a history of severe right lower limb pain that had begun 2 months earlier. The parents were unable to recall any trauma before the painful situation. Pain and allodynia were severe and extended from the toes to the gluteus area. She was low weight for her age (6700 g). The patient was on the maximum doses of gabapentin and amitriptyline accepted for her body weight and did not have the possibility to start rehabilitation due to severe pain and allodynia. After discussing the risks and potential benefits of a planned lumbar sympathetic block (LSB), the parents approved the interventional procedure. This is the first case report describing the LSB technique at such a young age.

Method: A lumbar sympathetic block was carried on at the third lumbar vertebral level, fluoroscopy-guided, and under general anesthesia (GA) initiated with ketamine iv. A 4-cm needle was introduced using a tunneled vision approach in an oblique view at the L3 level until adequate depth was confirmed in the lateral position. Safety considerations were taken in relation to the radiation dose and all drugs injected with dose adjustment to her body weight. The block was successful (the skin temperature increased by 2.8 °C) and was uneventful. Pain and allodynia were completely alleviated in the recovery room. At the follow-up after 3 and 8 weeks, the parents reported an 80% improvement in pain and allodynia, a 70% improvement in sleep, a weight gain of 900 g, and that she had started rehabilitation.

Conclusions: Lumbar sympathetic blocks can be considered at a very young age to treat CRPS if other non-invasive measures fail.

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腰交感神经阻滞治疗一名 18 个月大女孩的 CRPS：打破障碍的病例报告和文献综述。

背景：3岁以下儿童被诊断患有复杂性区域疼痛综合征（CRPS）。病例介绍：一名 18 个月大的女婴因右侧下肢剧烈疼痛而被转诊至疼痛诊所：一名 18 个月大的女婴因 2 个月前开始出现右下肢剧烈疼痛而被转诊至疼痛门诊。其父母无法回忆起疼痛发生前的任何外伤。她的疼痛和异感非常严重，从脚趾一直延伸到臀部。她的体重低于同龄人（6700 克）。患者服用的加巴喷丁和阿米替林剂量已达到其体重所能接受的最大剂量，但由于剧烈疼痛和异感症，她无法开始康复治疗。在讨论了计划进行的腰交感神经阻滞（LSB）的风险和潜在益处后，患者父母同意进行介入治疗。这是第一份描述在患者如此年幼的情况下采用腰交感神经阻滞技术的病例报告：方法：在第三腰椎水平进行腰交感神经阻滞，在荧光透视引导下进行，使用氯胺酮 iv 开始全身麻醉（GA）。在腰椎第三椎体水平，采用隧道式斜视法引入一根 4 厘米长的针头，直到侧卧位确认有足够的深度。考虑到辐射剂量和所有注射药物的安全性，根据她的体重调整了剂量。阻滞很成功（皮肤温度升高了 2.8 °C），过程也很顺利。在恢复室中，疼痛和异感症状完全缓解。在3周和8周后的随访中，她的父母报告说疼痛和异物感改善了80%，睡眠改善了70%，体重增加了900克，并且她已经开始康复训练：结论：如果其他非侵入性措施无效，可以考虑在孩子很小的时候就进行腰交感神经阻滞来治疗 CRPS。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.