{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:39:49Z","timestamp":1778222389264,"version":"3.51.4"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T00:00:00Z","timestamp":1643932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Sympathetic blocks are invaluable to prevent morbidity from Raynaud\u2019s phenomenon (RP). RP may occur in children with rheumatological disorders and causes severe pain, discoloration of digits, gangrene, and auto-amputation. We describe the planning and execution of sympathectomy blocks in children with rheumatological disorders presenting with RP.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 68 sympathectomy blocks were performed: 28 bilateral USGBs, two unilateral USGBs, and 10 intrathecal injections. Multiple interventions in a single day were frequently required. For safety, all USGBs were performed with an ultrasound with strict adherence to local anaesthetic volume was maintained, with periprocedure monitoring of 2\u20133\u2009hours. All blocks were performed by an experienced specialist. All children reported immediate pain relief with prevention of major amputation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>With meticulous planning, monitoring, and precautions, sympathectomy of limbs in pediatric rheumatological disorders with RP can be safely undertaken. Bilateral stellate ganglion block with ultrasound is safe in children, and clonidine is a useful adjunct for vasodilation and prolongation of the effect of sympathectomies in children.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/pm\/pnac015","type":"journal-article","created":{"date-parts":[[2022,1,28]],"date-time":"2022-01-28T12:13:19Z","timestamp":1643371999000},"page":"1211-1216","source":"Crossref","is-referenced-by-count":6,"title":["Sympathetic Blocks for Raynaud\u2019s Phenomena in Pediatric Rheumatological Disorders"],"prefix":"10.1093","volume":"23","author":[{"given":"Jyotsna","family":"Punj","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heena","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaurav","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narendra Kumar","family":"Bagri","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Subunit of Paediatric Rheumatology, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay Prakash","family":"Thakur","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7461-1328","authenticated-orcid":false,"given":"Longjam Darendrajit","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0343-8126","authenticated-orcid":false,"given":"Dhruv","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"V","family":"Darlong","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences , Ansari Nagar, New Delhi, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,2,4]]},"reference":[{"issue":"12","key":"2022070118364387800_pnac015-B1","doi-asserted-by":"crossref","first-page":"3518","DOI":"10.1002\/art.11340","article-title":"Occurrence of Raynaud\u2019s phenomenon in children ages 12\u201315 years: Prevalence and association with other common symptoms","volume":"48","author":"Jones","year":"2003","journal-title":"Arthritis Rheum"},{"key":"2022070118364387800_pnac015-B2","doi-asserted-by":"crossref","first-page":"438","DOI":"10.3389\/fphar.2016.00438","article-title":"Raynaud\u2019s phenomenon: A brief review of the underlying mechanisms","volume":"7","author":"Fardoun","year":"2016","journal-title":"Front Pharmacol"},{"issue":"4","key":"2022070118364387800_pnac015-B3","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1053\/j.trap.2015.10.015","article-title":"Interventional techniques for the management of digital ischemia due to Raynaud\u2019s phenomenon","volume":"18","author":"Sober\u00f3n","year":"2014","journal-title":"Tech Reg Anesth Pain Manag"},{"issue":"10","key":"2022070118364387800_pnac015-B4","doi-asserted-by":"crossref","first-page":"851","DOI":"10.4103\/ija.IJA_331_19","article-title":"Multiple bilateral ultrasound-guided stellate ganglion blocks to treat acute vasculitis in a recently diagnosed patient of systemic lupus erythematosus","volume":"63","author":"Punj","year":"2019","journal-title":"Indian J Anaesth"},{"issue":"5","key":"2022070118364387800_pnac015-B5","doi-asserted-by":"crossref","first-page":"1705","DOI":"10.1213\/ANE.0000000000002528","article-title":"Effect of stellate ganglion block on the regional hemodynamics of the upper extremity: A randomized controlled trial","volume":"126","author":"Kim","year":"2018","journal-title":"Anesth Analg"},{"issue":"6","key":"2022070118364387800_pnac015-B6","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1007\/s11916-014-0424-5","article-title":"Ultrasound-guided stellate ganglion block: Safety and efficacy","volume":"18","author":"Narouze","year":"2014","journal-title":"Curr Pain Headache Rep"},{"issue":"3","key":"2022070118364387800_pnac015-B7","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1111\/papr.12285","article-title":"Interventional procedures for chronic pain in children and adolescents: A review of the current evidence","volume":"16","author":"Shah","year":"2016","journal-title":"Pain Pract"},{"issue":"6","key":"2022070118364387800_pnac015-B8","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1136\/rapm-2018-100127","article-title":"Complications associated with stellate ganglion nerve block: A systematic review","volume":"44","author":"Goel","year":"2019","journal-title":"Reg Anesth Pain Med"},{"issue":"2","key":"2022070118364387800_pnac015-B9","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/0022-4804(73)90024-3","article-title":"Effects of lumbar sympathectomy on skin capillary blood flow in arterial occlusive disease","volume":"14","author":"Moore","year":"1973","journal-title":"J Surg Res"},{"key":"2022070118364387800_pnac015-B10","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1097\/00115550-200107000-00009","article-title":"Addition of clonidine increases duration and magnitude of vasodilative effect induced by sympathetic block with mepivacaine in dogs","volume":"26","author":"Kimura","year":"2001","journal-title":"Reg Anesth Pain Med"}],"container-title":["Pain 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