Nerve Block Completely Resolved Stubborn Cannabis Vomiting Syndrome in the ER

A patient with CHS unresponsive to conventional analgesics and antiemetics received a thoracic erector spinae plane block (ESPB) in the emergency department. Following the block, complete symptom relief was achieved, and the patient was discharged from the ED without hospital admission.

Single case report from an emergency department. Patient with chronic cannabis use presenting with refractory nausea, vomiting, and abdominal pain (CHS) was treated with a thoracic ESPB after standard treatments failed.

CHS is notoriously difficult to treat in the ER, often requiring prolonged stays or admission. A nerve block that provides immediate, complete relief could transform ER management of this increasingly common condition.

As cannabis use increases, CHS is becoming more common in ERs. Standard treatments (IV fluids, antiemetics, capsaicin cream) often fail, leading to repeated visits and admissions. A rapid procedural intervention could reduce healthcare burden and patient suffering simultaneously.

Single case report — may not be reproducible. Placebo effect cannot be excluded. The specific mechanism of ESPB in CHS is theoretical. No long-term follow-up reported. Not all EDs have staff trained in this procedure.