What is the role of cervical epidural blocks (CEBs) in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Some experts advocate cervical epidural blocks (CEBs) with LA, combined with corticosteroids or opioids for acute or palliative pain relief when diagnostic evaluation has not yet identified the cause or nature of the presenting disease or while the patient is awaiting more pertinent therapy, including surgery. Temporary pain management may be indicated for postoperative, posttraumatic, infectious (ie, herpes zoster), or cancer-related pain in patients awaiting treatment that is more definitive, that requires time to exert efficacy, or that reduces suffering when death is the expected outcome.

CEBs have been shown to offer therapeutic value for the treatment of upper extremity vascular insufficiency due to vaso-occlusive or vasospastic disorders and have been shown to improve vascular perfusion in disorders like frostbite and ergotamine toxicity. Some advocate CEBs for pain relief for patients when adjunctive or parallel treatment is underway or if multiple pharmaceutical trials are needed or if prolonged treatment duration through rehabilitation, time for healing, or disease resolution is needed.

Some experts advocate CEBs for cervical spinal degenerative disorders with radiculopathy, spinal stenosis, discogenic pain or spondylosis, failed surgery disorders, refractory cervicogenic headaches, spinal fractures, upper limb amputations, complex regional pain syndromes, acquired neuropathic pain from postherpetic neuralgia, or polyneuropathy from diabetes or chemotherapy. [21]

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