Management of cannabinoid hyperemesis syndrome with an erector spinae plane block in the emergency department

Abstract

Cannabinoid hyperemesis syndrome (CHS) is characterized by recurrent nausea, vomiting, and abdominal pain among patients with chronic cannabis use. Emergency department (ED) management is often difficult, as conventional analgesics and antiemetics are frequently ineffective. We describe a case of refractory CHS successfully managed in the ED with a thoracic erector spinae plane block (ESPB). Following the block, the patient had complete symptom relief and was able to be discharged from the ED, avoiding the need for hospital admission for symptom control. Through blockade of sympathetic visceral nociceptive and emetic signaling, the ESPB may be an effective ED treatment for select cases of CHS.

Keywords: Cannabinoid hyperemesis syndrome; Erector spinae plane block; Ultrasound-guided nerve block.