|Year : 2020 | Volume
| Issue : 2 | Page : 23-25
Stellate ganglion blockade as a treatment modality in ischemia and gangrene following insect bite
Bhaben Chandra Boro1, Pratibha Sahoo2
1 Aditya Pain and Spine Centre, Assam Medical College, Dibrugarh, Assam, India
2 Department of Anesthesiology and Critical Care, Assam Medical College, Dibrugarh, Assam, India
|Date of Submission||26-Nov-2020|
|Date of Acceptance||10-Dec-2020|
|Date of Web Publication||08-Mar-2021|
Bhaben Chandra Boro
Aditya Pain and Spine Centre, Dibrugarh, Assam
Source of Support: None, Conflict of Interest: None
We describe the case of a 34-year-old female patient who had ischemia of the hand and fingers following insect bite and underwent stellate ganglion block as treatment. She was otherwise fit without any significant past history. We recommend an early recognition of such cases with prompt treatment for a better outcome.
Keywords: Complex regional pain syndrome, insect bite, stellate ganglion block
|How to cite this article:|
Boro BC, Sahoo P. Stellate ganglion blockade as a treatment modality in ischemia and gangrene following insect bite. J Recent Adv Pain 2020;6:23-5
|How to cite this URL:|
Boro BC, Sahoo P. Stellate ganglion blockade as a treatment modality in ischemia and gangrene following insect bite. J Recent Adv Pain [serial online] 2020 [cited 2021 Apr 11];6:23-5. Available from: http://www.jorapain.com/text.asp?2020/6/2/23/310951
| Introduction|| |
Insect bite is one of the common reasons for patients to seek medical advice. The assessment is based on clinical experiences by using a combination of clinical features and risk factors. The clinical presentation usually varies from minor itch to septicemia. The incidence of insect bite is exactly not known as most are not reported. Study data recorded about 5.4/100,000 patients of insect bites per week on an average by general practitioners of England and Wales. Similarly, in India, the prevalence of papular urticaria in the dermatology outpatient clinic of Pondicherry was 5.3% in children <14 years of age and in Calcutta was 10.6% in children <5 years of age.
Stellate ganglion block at the C6 level is a technically simple procedure with readily identifiable landmarks with short recovery periods. It is a very effective interventional technique for the management of complex regional pain syndrome (CRPS) type I of upper extremities.
Background and aims
The objective is to report the use of stellate ganglion block in a patient with ischemia, gangrene, and CRPS-like symptoms in the right upper limb following insect bite.
| Case Report/Methods|| |
A 34-year-old woman was evaluated at our clinic with pain in the right hand. There were pain, swelling, as well as discoloration of index, middle, and ring fingers of the right hand following bite of an unknown insect on the dorsum of the right hand [Figure 1]. The symptoms developed within an hour and the patient visited our clinic on the 4th day following the bite. Pain was severe in intensity and radiating to her right arm. There were no aggravating or relieving factors. She had no significant past medical and surgical history. Her family history was unremarkable. She denied the use of alcohol, cigarettes, or recreational drugs. On physical examination, our patient exhibited hyperreflexia (pain score of 8/10) and bluish discoloration of three fingers in the right upper limb. Motor strength and sensations were normal. Color Doppler study of the right upper limb revealed reduced blood flow in the digital arteries of index, middle, and ring fingers. Fluoroscopy-guided right stellate ganglion block was given using 7 ml of 0.25% bupivacaine and 2 ml of depomedrol [Figure 2].
Stellate ganglion block which was given on day 4 of insect bite resulted in immediate relief of pain (from pain score of 8/10 to 2/10) and disappearance of discoloration within 12 h in index, middle, and ring fingers of the right hand. No immediate or late adverse effects were noted following the procedure.
| Results|| |
Stellate ganglion block which was given on day 4 of insect bite resulted in immediate relief of pain (from pain score of 8/10 to 2/10) and disappearance of discoloration within 12 h in index, middle, and ring fingers of the right hand.
| Conclusion|| |
Stellate ganglion block relieves the pain caused by ischemia of the upper limb following insect bite. Hence, timely intervention is very important to prevent risk of gangrene and amputation as soon as there is sign of ischemia.
| Discussion|| |
The incidence of CRPS has been reported to range from 5.5 to 26.2 per 100 000 persons per year, resulting from minor to major trauma. It is a clinical disorder that is characterized by severe, continuous pain, sensory, vasomotor, sudomotor/edema, and motor/trophic changes of the affected extremity. Our patient fulfills the criteria of CRPS as she had symptoms of spontaneous excessive continuous pain on light touch as well as swelling of the hand along with discoloration and raised temperature. There is also a possibility of insect venom-induced vasospasm which got relieved by vasodilatory effect of stellate ganglion block.
Stellate ganglion block using local anesthetic drugs is one of the most effective blocks widely used for vascular insufficiency of the upper extremities, CRPS, etc. A successful block may cause sympathetic blockade of the ipsilateral face and arm, Horner's Syndrome, increased temperature of face and arm, slightly blurred vision, hoarseness, hematoma, etc.
The mechanism of occurrence of CRPS following insect bite is not known, but it may be due to direct bite trauma or envenomation. In 2012, CRPS following snake bite was reported by Ergan et al. In January 2016, CRPS following viper bite was reported by Kleggetveit et al. Moreover, similarly, in July 2020, CRPS following a centipede bite was reported by Thumtecho et al.
The primary cause in this case is not known, but awareness is important for early diagnosis and appropriate management in such cases.
Written informed consent was taken from the patient for publication of this case report and accompanying images.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]