a Institute of Neural Therapy and Regulatory Medicine, Sabadell, Barcelona, Spain
b Campus Docent de Sant Joan de Déu, Barcelona, Spain
c Neural Therapy Research Foundation, Sabadell, Barcelona, Spain.

Background: Post COVID-19 syndrome (PC-19S) appears to be independent of acute illness severity and humoral response. The involvement of the autonomic nervous system (ANS), expressed by dysautonomia, has been hypothesized as a contributor. Several studies have associated the therapeutic effects of local anesthetics (LA) to their action on the ANS. To the best of our knowledge, this is the first report of therapeutic injections with LA linked to clinical improvement in a patient with PC-19S.
Patient concerns and diagnoses: This was a 54-year-old-man with postCOVID-19 symptoms lasting 14 weeks, including fatigue, breathlessness, diarrhea, muscle pain, and emotional lability.
Interventions and outcome: Injections of 0.5% procaine in the stellate ganglion (SG) and sphenopalatine ganglion (SPG), and in clinically relevant points in the scalp, thorax, and abdomen were performed 3 times over 3 months. The patient reported progressive improvement and was asymptomatic upon completing the treatment. Prescribed medications were discontinued. The 36-Item Short Form Health Survey (SF-36) score showed significant improvement across all SF-36-domains.
Conclusion: Subanesthetic doses of LA injected in clinically relevant points led to rapid and complete symptom resolution in this patient with PC-19S. Targeted LA injections may have therapeutic benefits in PC-19S and in other chronic diseases linked to stress and inflammation.
Abbreviations: ANS = autonomic nervous system, LA = local anesthetics, MTP = myofascial tension points, PC-19S = postCOVID-19 syndrome, QoL = quality of life, SG = stellate ganglion, SNS = sympathetic nervous system, SPG = sphenopalatine ganglion. Keywords: case report, local anesthetics, postCOVID-19, procaine, neural therapy.