Sympathetic nerve entrapment point injection for intractable nausea and vomiting in pregnancy: a case report

Abstract

Nausea and vomiting during pregnancy (NVP) occurs in up to 80% of pregnant women worldwide. Severe intractable NVP accompanied by acute starvation may threaten the health of the mother and fetus, and greatly reduce the quality of life during pregnancy. Symptoms that cannot be controlled with pharmacotherapy are difficult to relieve in severe NVP. Dysfunction of the autonomic and enteric nervous systems is an important component of NVP pathogenesis. It is thought to be controlled by the autonomic nervous system. In the present case, a 30-year-old married female came to the emergency department complaining of severe nausea and vomiting. Her symptoms had not improved with medication, such as Diclrectin® and intravenous metoclopramide. Tenderness was detected in the multifidus area on both sides of the T7 spinal cord level. Normal saline (3 cc) was injected into the multifidus areas at both tenderness points, and her symptoms improved 30 min after the injections because intervertebral pressure and constriction of the vasa nervorum were alleviated. This approach improved the compression of sympathetic preganglionic fibers and increased blood flow to the sympathetic nerves. Nausea and vomiting symptoms improved as the imbalance in the autonomic nervous system improved and vagal tone was normalized. Sympathetic nerve entrapment point injection should be considered an alternative treatment to control severe NVP not resolved by medication.