Two years follow-up of continuous erector spinae plane block in a patient with upper extremity complex regional pain syndrome type I.

Abstract

Recalcitrant complex regional pain syndrome (CRPS) type 1 is a devastating condition. We report a case of a patient in their twenties with left hand and forearm CRPS type I, transiently responsive to spinal cord stimulation, thoracic sympathectomy, and multimodal analgesia. The investigators initiated a trial of a single-shot erector spinae plane block at the T2 level, resulting in a clinically significant improvement in pain, function, vasomotor and sudomotor symptoms transiently for a 36-hour interval. As a result, a permanent e-port catheter implantation under combined ultrasound and fluoroscopic guidance was trialed. Two-year follow-up of the continuous erector spinae plane block (CESPB) indicated an 80% reduction in pain scores from baseline, and a 50% reduction in opiate consumption, with a clinically significant reduction in swelling, color changes, allodynia, and temperature asymmetry. Recalcitrant CRPS type 1 is a challenging life-altering condition that results in a cyclical triad of chronic pain, disability, and impaired psychosocial health. The profound and prolonged analgesic response to CESPB, highlights the clinical utility of this technique, and warrants more clinical investigation.