Erythromelalgia in the pediatric patient: role of computed-tomography-guided lumbar sympathetic blockade

Anjana Kundu,1 Mahmood Rafiq,2 Patrick S Warren,3 Joseph D Tobias2,4 1Department of Anesthesiology, Dayton Children’s Hospital, Dayton, 2Department of Anesthesiology and Pain Medicine, 3Department of Radiology, Nationwide Children’s Hospital, 4Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA Abstract: Erythromelalgia (EM) is an uncommon condition characterized by erythema, increased skin temperature, and burning pain, most frequently occurring in the lower extremities. The pain is generally very severe and treatment can be extremely challenging, especially in the pediatric and adolescent population. We report a series of three cases of primary EM in pediatric patients involving the lower extremities, refractory to medical treatment that responded favorably to computed-tomography-guided lumbar sympathetic blockade. There was a significant improvement in pain scores, quality of life, and overall function as well as decreased analgesic requirements. Lumbar sympathetic blockade should be considered as a therapeutic modality in pediatric and adolescent patients with EM who are refractory to other treatments. Keywords: primary erythromelalgia, secondary erythromelalgia, computed tomography guided, lumbar sympathetic blockade&nbsp