Lumbar sympathetic block with botulinum toxin type b for complex regional pain syndrome: A case study

Lumbar sympathetic block (lsb) is an effective method for relief of sympatheticallymediated pain in the lower extremities. to prolong the sympathetic blockade,sympathetic destruction with alcohol or radiofrequency has been used. the preganglionicsympathetic nerves are cholinergic,and botulinum toxin (btx) has beenfound to inhibit the release of acetylcholine at the cholinergic nerve terminals. moreover,btx type b (btx-b) is more convenient to use than btx type a. based on these findings,we performed lsb on the 2 patients with complex regional pain syndrome (crps) in thelower extremity. levobupivacaine 0.25% 5 ml mixed with btx-b 5,000 iu was givenunder fluoroscopic guidance. two months after lsb with btx-b,pain intensity and theleeds assessment of neuropathic symptoms and signs (lanss) score were significantlyreduced. allodynia and coldness disappeared and skin color came back to normal. inconclusion,btx-b can produce an efficacious and durable sympathetic blocking effecton patients with crps. © 2015,american society of interventional pain physicians. all rights reserved.