A patient with refractory cannabinoid hyperemesis syndrome had complete symptom relief after a thoracic erector spinae plane block in the ER, avoiding hospital admission entirely.
Emergency physicians, cannabis users experiencing CHS, and anyone interested in novel treatments for cannabinoid hyperemesis syndrome.
What the researchers found
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.
Why it matters
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.
The numbers in context
1 patient with refractory CHS. Complete symptom relief after thoracic ESPB. Discharged from ED (avoided admission). Proposed mechanism: blockade of sympathetic visceral nociceptive and emetic signaling.
How the study worked
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.
What this study cannot tell us
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.
How to read the evidence
Single case report — the lowest evidence level but introduces a novel treatment approach that warrants further study.
When this study was published
Published in 2026, proposing a new interventional approach for the growing CHS problem in emergency departments.
The bigger picture
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.
Questions still open
- Would ESPB work consistently for CHS? What is the mechanism of action in visceral hyperemesis? Should this become a standard CHS protocol?
Common questions
What is cannabinoid hyperemesis syndrome?
Could a nerve block cure CHS?
Read the original research
Management of cannabinoid hyperemesis syndrome with an erector spinae plane block in the emergency department.
The American journal of emergency medicine, 100, 93-95
Citation
Gawel, Richard J; Ho, Emily; Gottlieb, Michael; Kramer, Jeffrey A; Shalaby, Michael. (2026). Management of cannabinoid hyperemesis syndrome with an erector spinae plane block in the emergency department.. The American journal of emergency medicine, 100, 93-95. https://doi.org/10.1016/j.ajem.2025.11.023