LAUSR

OBJECTIVE Sympathetic blocks are invaluable to prevent morbidity from Raynaud's phenomena (RP). RP may occur in children with rheumatological disorders and causes severe pain, discolouration of digits, gangrene and auto-amputation.We describe planning and execution of sympathectomy blocks in children of rheumatological disorders presenting with RP. METHODS With upper limb involvement, ultrasound guided stellate ganglion block (USGB) was given with ropivacaine and clonidine. When all four limbs were involved, intrathecal block with bupivacaine and clonidine was also given. RESULTS A total of 68 sympathectomy blocks were performed- 28 bilateral USGB, 2 unilateral USGB and 10 intrathecal injections. Multiple interventions in a single day were frequently required. For safety, all USGB blocks were performed with an ultrasound and strict adherence to local anaesthetic volume was done with peri-procedure monitoring of 2-3 hours. All blocks were performed by an experienced specialist.All children reported immediate pain relief with prevention of major amputation. CONCLUSION With meticulous planning, monitoring and precautions, sympathectomy of limbs in paediatric rheumatologic disorders with RP can be safely undertaken.