Myofascial pain syndrome (MPS) may persist for many years and is often refractory to traditional therapeutic approaches including
pharmacotherapy, focal tenderness infiltration by
local anesthetic and
corticosteroids,
physical therapy and behavioral modification. This report describes three cases of MPS following
coronary artery bypass graft, inadequate positioning during abdominal
hysterectomy, and excessive physical effort refractory to conventional therapeutic approaches. Three patients were successfully treated with repeated nerve stimulator-guided paravertebral block using a mixture of
bupivacaine and
clonidine. Physical examinations including a complete neurological assessments were unremarkable. Relevant diagnostic imaging (X-ray, magnetic resonance imaging, computed tomography) and laboratory evaluations also failed to demonstrate any significant structural disorders or systemic diseases that might have been responsible for their
pain. Nerve stimulator-guided paravertebral block was performed at the dermatomes corresponding to the thoracic myofascial
pain region. Each point was injected with 4 mL of the
local anesthetic solution. If the
pain returned, a second paravertebral block was performed. The three patients were
pain-free over a follow-up period up to 2 years. Our report suggests that nerve stimulator-guided paravertebral blockade could be a useful treatment for MPS refractory to traditional therapeutic approaches.