Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea.
Pain Med. 2024 Sep 1;25(9):553-562. doi: 10.1093/pm/pnae038.
To investigate the predictive value of thoracic sympathetic ganglion block (TSGB) in response to ketamine infusion therapy (KIT) and spinal-cord stimulation (SCS) in patients with chronic upper-extremity pain including complex regional pain syndrome (CRPS).
Retrospective.
Tertiary hospital single-center.
Patients who underwent TSGB receiving KIT or SCS within a 3-year window.
Positive TSGB outcomes were defined as ≥2 0-10 Numerical Rating Scale (NRS) score reduction at 2 weeks post-procedure. Positive KIT and SCS outcomes were determined by ≥2 NRS score reduction at 2-4 weeks post-KIT and ≥4 NRS score reduction at 2-4 weeks post-SCS implantation, respectively.
Among 207 patients who underwent TSGB, 38 received KIT and 34 underwent SCS implantation within 3 years post-TSGB; 33 patients receiving KIT and 32 patients receiving SCS were included. Among 33 patients who received KIT, 60.6% (n = 20) reported a ≥ 2 0-10 NRS pain-score reduction. Positive response to TSGB occurred in 70.0% (n = 14) KIT responders, significantly higher than that in 30.8% (n = 4) KIT non-responders. Multivariable analysis revealed a positive association between positive responses to TSGB and KIT (OR 7.004, 95% CI 1.26-39.02). Among 32 patients who underwent SCS implantation, 68.8% (n = 22) experienced short-term effectiveness. Positive response to TSGB was significantly higher in SCS responders (45.5%, n = 10) than in non-responders (0.0%). However, there were no associations between pain reduction post-TSGB and that post-KIT or post-SCS.
A positive response to TSGB is a potential predictor for positive KIT and SCS outcomes among patients with chronic upper-extremity pain, including CRPS.
探讨胸交感神经节阻滞（TSGB）对慢性上肢疼痛（包括复杂性区域疼痛综合征（CRPS））患者接受氯胺酮输注治疗（KIT）和脊髓刺激（SCS）的预测价值。
回顾性研究。
三级医院单中心。
在 3 年内接受 TSGB 治疗并接受 KIT 或 SCS 的患者。
阳性 TSGB 结果定义为治疗后 2 周时疼痛评分（0-10 数字评分法（NRS））至少降低 2 分。阳性 KIT 和 SCS 结果分别定义为 KIT 治疗后 2-4 周时疼痛评分至少降低 2 分和 SCS 植入后 2-4 周时疼痛评分至少降低 4 分。
在 207 例行 TSGB 的患者中，有 38 例在 TSGB 后 3 年内接受了 KIT，34 例行 SCS 植入术；共有 33 例接受 KIT 和 32 例接受 SCS 的患者纳入研究。在接受 KIT 的 33 例患者中，60.6%（n=20）报告疼痛评分降低≥2 分。TSGB 阳性反应者中，KIT 治疗有效者占 70.0%（n=14），显著高于无效者的 30.8%（n=4）。多变量分析显示，TSGB 阳性反应与 KIT 治疗之间存在正相关（OR 7.004，95%CI 1.26-39.02）。在接受 SCS 植入的 32 例患者中，22 例（68.8%）短期有效。SCS 治疗有效者的 TSGB 阳性反应率（45.5%，n=10）显著高于无效者（0.0%）。然而，TSGB 治疗后疼痛减轻与 KIT 或 SCS 治疗后疼痛减轻之间无相关性。
TSGB 阳性反应是慢性上肢疼痛（包括 CRPS）患者接受 KIT 和 SCS 治疗后获得阳性疗效的潜在预测因素。
