Upper Back Nerve Block Superior for Easing Chronic Arm Pain

TOPLINE:

A new study finds that ultrasound-guided thoracic paravertebral block (TPVB) is more effective than stellate ganglion block (SGB) for treating chronic upper arm pain, providing better pain relief and increasing hand temperature more significantly after the procedure.

METHODOLOGY:

• This multicenter, prospective, randomized trial included 70 patients with chronic upper extremity pain who were randomly assigned to receive either TPVB or SGB.
• Participants’ pain scores, temperatures, and brachial artery blood flow were measured 20 minutes post-block.
• Patients in the TPVB group received a 10-mL injection of 1% mepivacaine in the upper back, while those in the SGB group received a 5-mL injection in the neck.
• Success was defined as an increase in hand temperature of at least 1.5 °C, indicating an effective nerve block.
• Pain levels were also assessed before the procedure, 20 minutes after, and at weeks 1 and 4 after the injection.

TAKEAWAY:

• TPVB showed a higher rate of success than SGB in providing nerve block for upper arm pain at 20 minutes after the injection (62.9% vs 38.2%; P = .041).
• The increase in hand temperature was significantly greater in the TPVB group than in the SGB group (2.0 °C vs 1.1 °C; P = .008).
• Both groups experienced pain relief 20 minutes after the procedure, but those in the group that received TPVB reported lower pain scores (4.3 vs 5.4 for SGB; P = .038).
• Both groups had similar pain relief at the follow-ups of 1 and 4 weeks.

IN PRACTICE:

“Ultrasound-guided TPVB, using local anesthetic alone, shows promise as a diagnostic block” for sympathetically maintained pain in the upper extremeties, the authors wrote.

SOURCE:

The study, led by Jeongsoo Kim, MD, of the Department of Anesthesiology and Pain Medicine at Seoul National University Hospital, in South Korea, was published online on July 25, 2024, in Anesthesia & Analgesia.

LIMITATIONS:

Different volumes of mepivacaine were injected in patients in the TPVB and SGB groups, which could have influenced the success rates observed. Other limitations included the absence of a control group and small study populations.

DISCLOSURES:

The study did not receive any funding. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.