A 39-year-old woman diagnosed with complex regional pain syndrome type I of the upper right limb, with a previous history of two arthroscopic surgeries on that shoulder.
The last surgery presented as complication an infection caused by pseudomona which was successfully treated.
The patient complained of moderate to severe pain in her right upper extremity every day, which did not respond to conventional analgesic treatments.
The patient presented edema, color changes and trophic changes in that extremity.
Apart from CRPS, the patient was in good general health, neurologically normal, without hypertension or diabetes.
It was decided to perform a Stellate Ganglio Block for which intravenous access was established and the patient was monitored with electrocardiogram, blood pressure and O2 saturation.
Paratracheal approach was used for block using a 3.5 cm long needle 10 ml of 1 % procaine without epinephrine; C6 mapping was performed to discern the level of C6 cricoid cartilage.
The transverse process of the sixth vertebra was fixed between the trachea and the carotid sheath.
Prior to the injection, aspiration was negative in order to rule out the puncture of any vascular structure.
Horner's syndrome developed after the blockade.
Five minutes after the blockade, the patient reported discomfort, dizziness and severe headache.
The patient's blood pressure increased from 235/135 mmHg, sinus tachycardia.
Hypertension was relieved with the administration of intravenous metoprolol in fixed doses, dropping blood pressure to 140/90 mmHg.
After vital signs were restored to normal levels, the patient complained of dizziness and fatigue accompanied by headache and hiccups, reason why she was hospitalized.
An ECG, neurological examination and a head CT were performed, these tests revealed no abnormalities.
Thyroid tests were also performed to exclude thyrotoxicosis which were normal.
Days later, the patient returned to the clinic and manifested weakness and a 'head movement' which had no medical explanation.
The movement disappeared two months later without the need to administer medication.
