Intervention Review

Local anaesthetic sympathetic blockade for complex regional pain syndrome

  1. M Soledad Cepeda1,*,
  2. Daniel B Carr2,
  3. Joseph Lau3

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 29 MAY 2005

DOI: 10.1002/14651858.CD004598.pub2

Database Title

Additional Information

How to Cite

Cepeda MS, Carr DB, Lau J. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004598. DOI: 10.1002/14651858.CD004598.pub2.

Author Information

  1. 1

    Johnson & Johnson Pharmaceutical Research and Development, Pharmacoepidemiology, Titussville, NJ, USA

  2. 2

    Tufts Medical Center, Department of Anesthesia, Boston, USA

  3. 3

    Tufts Medical Centre, New England Medical Centre/Tufts Evidence-based Practice Center Institute for Clinical Research and Health Policy Studies, Boston, MA, USA

*M Soledad Cepeda, Pharmacoepidemiology, Johnson & Johnson Pharmaceutical Research and Development, PO BOX 200, M/S K304, Titussville, NJ, 08560, USA. scepeda@prdus.jnj.com. scepeda@tufts-nemc.org.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Local anaesthetic blockade of the sympathetic chain is widely used to treat reflex sympathetic dystrophy (RSD) and causalgia. These two pain syndromes are now conceptualized as variants of a single entity: complex regional pain syndrome (CRPS). A recent meta-analysis of the topic has been published. However, this study only evaluated studies in English language and therefore it could have overlooked some randomized controlled trials.

Objectives

This systematic review had three objectives: to determine the likelihood of pain alleviation after sympathetic blockade with local anesthetics in the patient with CRPS; to assess how long any benefit persists; and to evaluate the incidence of adverse effects of the procedure.

Search methods

We searched the Cochrane Pain, Palliative and Supportive Care Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, and conference abstracts of the World Congresses of the International Association for the Study of Pain. Bibliographies from retrieved articles were also searched for additional studies.

Selection criteria

We considered for inclusion randomized controlled trials (RCTs) that evaluated the effect of sympathetic blockade with local anesthetics in children or in adult patients to treat RSD, causalgia, or CRPS.

Data collection and analysis

The outcomes of interest were the number of patients who obtained at least 50% of pain relief shortly after sympathetic blockade (30 minutes to 2 hours) and 48 hours or later. We also assessed the presence of adverse effects in each treatment arm. A random effects model was used to combine the studies.

Main results

Two small randomized double blind cross over studies that evaluated 23 subjects were found. The combined effect of the two trials produced a relative risk (RR) to achieve at least 50% of pain relief 30 minutes to 2 hours after the sympathetic blockade of 1.17 (95% CI 0.80-1.72). It was not possible to determine the effect of sympathetic blockade on long-term pain relief because the authors of the two studies evaluated different outcomes.

Authors' conclusions

This systematic review revealed the scarcity of published evidence to support the use of local anesthetic sympathetic blockade as the 'gold standard' treatment for CRPS. The two randomized studies that met inclusion criteria had very small sample sizes, therefore, no conclusion concerning the effectiveness of this procedure could be drawn. There is a need to conduct randomized controlled trials to address the value of sympathetic blockade with local anesthetic for the treatment of CRPS.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Local anesthetic sympathetic blockade for complex regional pain syndrome

The efficacy of local anesthetic sympathetic blockade for CRPS is unknown. The sympathetic nervous system has been implicated in the pathophysiology of reflex sympathetic dystrophy (RSD) and causalgia which are now conceptualized as variants of a single entity: complex regional pain syndrome (CRPS). Consequently blockade of the sympathetic nervous system is widely used to treat this pain syndrome. The reviewers sought to evaluate the efficacy of sympathetic blockade with local anesthetic. This systematic review reveals the scarcity of published evidence to support the use of local anesthetic sympathetic blockade as the "gold standard" treatment for CRPS and raises questions as to its usefulness.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

使用局部麻醉劑阻斷交感神經治療複雜區域疼痛症後群

使用局部麻醉劑阻斷交感神經鏈被廣泛用來治療複雜的交感神經失養症(RSD)和燒灼性神經痛，這兩個疼痛綜合症，目前的概念上已被統整為複雜區域疼痛症候群(CRPS)。最近的這個標題的綜合分析的已經發表，不過，這只是一篇英文的評價研究，它可能忽略了一些隨機對照試驗。

目標

本篇有系統的整體評論可分為三個目標：首先，在罹患CRPS病人以局部麻醉劑進行交感神經阻斷後，評估其疼痛緩解的可能性。再來，評估此治療的好處能持續多久。最後，評估整個療程可有不良影響產生。

搜尋策略

我們搜尋了the Cochrane Pain, Palliative and Supportive Care Register，the Cochrane Central Register of Controlled Trials，MEDLINE，EMBASE，LILACS，和conference abstracts of the World Congresses of the International Association for the Study of Pain等資料庫。圖書誌則從其他研究中搜尋檢索得來。

選擇標準

我們收納了罹患複雜的交感神經失養症(RSD)和燒灼性神經痛或複雜區域疼痛症候群(CRPS)的孩童與成年患者，使用局部麻醉劑進行交感神經阻斷治療後成效之隨機對照試驗。

資料收集與分析

結果效益是以接受交感神經阻斷後(30分鐘至2小時)和48小時或更久時間，評估病患能獲得至少50 ％的疼痛緩解的人數來決定。我們還評估了每個治療的不利影響。以隨機效應模式結合此研究。

主要結論

本評論包含了兩個小的隨機雙盲交叉研究，評估23個個案。這兩個試驗產生的綜合效果，接受交感神經阻斷後(30分鐘至2小時)，評估病患能獲得至少50 ％疼痛緩解的相對危險(RR)為1.17(95 ％CI為0.80 – 1.72)。因為兩項研究作者的評價結果不同，所以使用交感神經阻斷治療長期疼痛的影響，結果是不能確定的。

作者結論

有關支持使用局部麻醉劑作為交感神經阻斷治療CRPS的黃金標準，這方面有系統的評估發表很少。本篇所收納的兩個隨機試驗的樣本很小，因此，對這個程序的成效沒有定論。所以有必要進行隨機對照試驗，以確定使用局部麻醉劑做交感神經阻斷治療CRPS的價值。

翻譯人

本摘要由三軍總醫院謝凱芝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

使用局部麻醉劑阻斷交感神經治療CRPS的效果尚未清楚。交感神經系統被認為與複雜的交感神經失養症(RSD)和燒灼性神經痛，即與現今統一概念中的複雜區域疼痛症候群(CRPS)之病生理有關。因此交感神經系統阻斷被廣泛用來治療疼痛症候群。評論者尋求使用局部麻醉劑阻斷交感神經的療效。有關支持使用局部麻醉劑作為交感神經阻斷治療CRPS的黃金標準，這方面有系統的評估發表很少，因此它的用處仍被質疑。

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