A Series of Stellate Ganglion Block for Ischemic Monomelic Neuropathy Chronic Ischemic Pain after Arteriovenous Shunt Surgery-A Case Report

We report a case of ischemic monomelic neuropathy (IMN) occurring in a 51 years old diabetic female patient with end-stage renal disease. She underwent arteriovenous (A-V) shunt creation but subsequent severe steal syndrome developed. Unfortunately, she complained moderate to severe left forearm pain and a cold hand after revision of A-V shunt for more than 6 months. Under the impression of ischemic neuropathy, she was prescribed with weak opioid, antiepileptics and mecobalamine. She was transferred to our pain clinic because of inadequate pain control. We arranged left side stellate ganglion block once per week for 2 months to improve upper arm circulation and relieve pain and buprenorphone also added for breakthrough pain. Outcome measurements for peripheral circulation and chronic pain were done by infrared thermography and numerical rating scale respectively. Gradually, her intractable pain was controlled with much satisfaction.