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| Name | Class |
|---|---|
| SMG-SNU Boramae Medical Center | OTHER |
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The purpose of this study is to investigate the effect of ultrasound-guided thoracic paravertebral block (TPVB) when performing sympathetic block for upper limb pain control.
Well-trained pain physicians performs all US-guided stellate ganglion block(SGB)s or US-guided thoracic paravertebrl block(TPVB)s, who is not involved in evaluating study variables. Electrocardiography, noninvasive blood pressure, heart rate, and peripheral oxygen saturation were monitored for all patients before, while, and after conducting procedure.
For US-guided SGB, patients are supine positioned, and skin preparation on injection site is done with chlorohexidine. Procedure is conducted under ultrasound guidance at C6 level. 5 ml of 1% mepivacaine is injected for the SGB group. Syringes are prepared by one nurse who do not involved in other steps of this study.
For US-guided TPVB, patients are prone positioned, and skin preparation on injection site is done with chlorohexidine. Procedure is conducted under ultrasound guidance at T2 paravertebral space. 10 ml of 1% mepivacaine is injected for the TPVB group. Syringes are prepared by one nurse who do not involved in other steps of this study.
Temperature measurement is conducted 2 times (before US-guided SGB or TPVB and after 20 minutes) at both hands by one person who's not involved in other measuring in the study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| US-SGB | Active Comparator | 5 ml of 1% mepivacaine is injected for stellate ganglion block using the Ultrasound(US)-guided lateral approach at the sixth cervical vertebral level. |
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| US-TPVB | Active Comparator | 10 ml of 1% mepivacaine is injected for thoracic paravertebral block using the Ultrasound(US)-guided sagittal approach at the second thoracic paravertebral space. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| US-SGB | Procedure | Well trained pain physician performs all the ultrasound(US)-guided stellate ganglion block(SGB)s, who is not involved in evaluating study variables. Electrocardiography, noninvasive blood pressure, heart rate, and peripheral oxygen saturation were monitored for all patients before, while, and after conducting procedure. For US-guided SGB, patients are supine positioned, and skin preparation on injection site is done with chlorohexidine. Procedure is conducted under ultrasound guidance at C6 level. 5 ml of 1% mepivacaine is injected for the US-SGB group. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients reaching > 1.5°C rise of temperature in the ipsilateral hand compared to the contralateral hand | Temperature is measured with a laser thermometer on the palmar aspect of 3 cm below from the middle finger. | 20 minutes after US-guided thoracic paravertebral block or US-guided stellate ganglion block |
| Measure | Description | Time Frame |
|---|---|---|
| Difference of temperature change (°C) between ipsilateral hand and contralateral hand | Temperature is measured with a laser thermometer on the palmar aspect of 3 cm below from the middle finger. | 20 minutes after US-guided thoracic paravertebral block or US-guided stellate ganglion block |
| Severity of pain |
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Inclusion Criteria:
Patients with a new or known diagnosis of chronic neuropathic pain lasting more than 3 months in the upper extremity
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Youn Moon Jee, MD, PhD | Seoul National University Hospital | Study Director |
| Jeongsoo Kim, MD | SMG-SNU Boramae Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | South Korea |
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| US-TPVB | Procedure | Well trained pain physician performs all the ultrasound(US)-guided thoracic paravertebral block(SGB)s, who is not involved in evaluating study variables. Electrocardiography, noninvasive blood pressure, heart rate, and peripheral oxygen saturation were monitored for all patients before, while, and after conducting procedure. For US-guided TPVB, patients are prone positioned, and skin preparation on injection site is done with chlorohexidine. Procedure is conducted under ultrasound guidance at T2 paravertebral space. 10 ml of 1% mepivacaine is injected for the US-TPVB group. |
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The severity of the pain will be evaluated before the block and 20 minutes, 1 week and 4 weeks after the block using an 11-pointed NRS (numerical rating scale) pain score. |
| Time before block and 20 minutes and 1 week and 4weeks after US-guided thoracic paravertebral block or US-guided stellate ganglion block |
| Patient global impression change (PGIC) | The PGIC will be evaluated 20 minutes, 1 week and 4 weeks after the block using a 5-point Likert scale. | Time 20 minutes and 1 week and 4 weeks after US-guided thoracic paravertebral block or US-guided stellate ganglion block |
| Comparison of Korean version CISS(Cold Intolerance Symptom Severity) Questionnaire | Check the CISS before the procedure and 4 weeks after the procedure. | Time before block and 4 weeks after US-guided thoracic paravertebral block or US-guided stellate ganglion block |
| Blood flow velocity measurement in upper extremity vessel(ipsilateral brachial artery) using ultrasound | The blood flow velocity in the ipsilateral brachial artery will be measured before the block and 20 minutes after the block using a Doppler mode ultrasound device. | Time before block and 20minutes after US-guided thoracic paravertebral block or US-guided stellate ganglion block |
| ID | Term |
|---|---|
| D020918 | Complex Regional Pain Syndromes |
| D051474 | Neuralgia, Postherpetic |
| D010591 | Phantom Limb |
| D010149 | Pain, Postoperative |
| D009437 | Neuralgia |
| ID | Term |
|---|---|
| D001342 | Autonomic Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010468 | Perceptual Disorders |
| D019954 | Neurobehavioral Manifestations |
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
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