Patient tolerability of suprascapular and median nerve blocks for the management of pain in post-stroke shoulder-hand syndrome.

Abstract

Current management options for pain in stroke patients with the shoulder-hand syndrome (SHS) are limited and often ineffective. The use of peripheral nerve blocking in SHS has been limited due to concerns of hyperalgesia and allodynia in these patients. This study assessed the tolerability of suprascapular nerve (SSN) and median nerve blocks for acute control of pain in patients with post-stroke SHS. All SHS patients fulfilled diagnosis using the Budapest criteria. Patient tolerability was defined by a composite score that included a change on the visual analog scale (VAS) from baseline for shoulder and hand pain, presence of adverse events, and a self-reported patient satisfaction score. Pain assessment was performed 1 h before (baseline), and 1 h and 2 weeks after the procedure. Five patients (68.5 ± 9.5 years) with post-stroke SHS underwent SSN and median nerve blocks. Participant assessment 1 h after the procedure indicated that the 2 blocking procedures were well tolerated and that VAS scores for shoulder and hand pain decreased by 79% (- 62.6 mm ± 25.6; p = 0.043) and 48% (- 33 mm ± 40.2; p = 0.080), respectively from baseline. After 2 weeks, average VAS scores remained 56% and 37% below baseline, respectively. There were no adverse events and all patients were satisfied after the procedure. Suprascapular and median nerve blocks are safe and well-tolerated procedures for acute pain control in post-stroke SHS. Further studies should address the benefit of these procedures on overall pain reduction, functional recovery, and quality of life in SHS patients.