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Local anaesthetic sympathetic blockade for complex regional pain syndrome

  1. Tasha R Stanton1,2,*,
  2. Benedict M Wand3,
  3. Daniel B Carr4,
  4. Frank Birklein5,
  5. Gunnar L Wasner6,
  6. Neil E O'Connell7

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 19 AUG 2013

Assessed as up-to-date: 31 JUL 2013

DOI: 10.1002/14651858.CD004598.pub3


How to Cite

Stanton TR, Wand BM, Carr DB, Birklein F, Wasner GL, O'Connell NE. Local anaesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004598. DOI: 10.1002/14651858.CD004598.pub3.

Author Information

  1. 1

    Neuroscience Research Australia, Randwick, Australia

  2. 2

    University of South Australia, The Sansom Institute for Health Research, School of Health Sciences, Adelaide, Australia

  3. 3

    The University of Notre Dame Australia, School of Physiotherapy, Fremantle, W, Australia

  4. 4

    Tufts Medical Center, Department of Anesthesia, Boston, USA

  5. 5

    Johannes Gutenberg University, University Medical Centre, Mainz, Germany

  6. 6

    Christian-Albrechts University of Kiel, Neurological Clinic, Kiel, Schleswig-Holestein, Germany

  7. 7

    Brunel University, Centre for Research in Rehabilitation, School of Health Sciences and Social Care, Uxbridge, Middlesex, UK

*Tasha R Stanton, t.stanton@neura.edu.au. tasha.stanton@unisa.edu.au.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 AUG 2013

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Abstract

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

Background

This is an update of the original Cochrane review published in The Cochrane Library, 2005, Issue 4, on local anaesthetic blockade (LASB) of the sympathetic chain used to treat complex regional pain syndrome (CRPS).

Objectives

To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure.

Search methods

We updated searches of the Cochrane Pain, Palliative and Supportive Care Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library (Issue 11 of 12, 2012), MEDLINE (1966 to 22/11/12), EMBASE (1974 to 22/11/12), LILACS (1982 to 22/11/12), conference abstracts of the World Congresses of the International Association for the Study of Pain (1995 to 2010), and various clinical trial registers (inception to 2012). We also searched bibliographies from retrieved articles for additional studies.

Selection criteria

We considered for inclusion randomised controlled trials (RCTs) that evaluated the effect of sympathetic blockade with local anaesthetics in children or adults with CRPS.

Data collection and analysis

The outcomes of interest were reduction in pain intensity levels, the proportion who achieved moderate or substantial pain relief, the duration of pain relief, and the presence of adverse effects in each treatment arm.

Main results

We included an additional 10 studies (combined n = 363) in this update. Overall we include 12 studies (combined n = 386). All included studies were assessed to be at high or unclear risk of bias.

Three small studies compared LASB to placebo/sham. We were able to pool the results from two of these trials (intervention n = 23). Pooling did not demonstrate significant short-term benefit for LASB (in terms of the risk of a 50% reduction of pain scores).

Of two studies that investigated LASB as an addition to rehabilitation treatment, the only study that reported pain outcomes demonstrated no additional benefit from LASB.

Eight small randomised studies compared sympathetic blockade to another active intervention. Most studies found no difference in pain outcomes between sympathetic block and other active treatments.

Only five studies reported adverse effects, all with minor effects reported.

Authors' conclusions

This update has found similar results to the original systematic review. There remains a scarcity of published evidence to support the use of local anaesthetic sympathetic blockade for CRPS. From the existing evidence it is not possible to draw firm conclusions regarding the efficacy or safety of this intervention but the limited data available do not suggest that LASB is effective for reducing pain in CRPS.

 

Plain language summary

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

Local anaesthetic sympathetic blockade for complex regional pain syndrome

Local anaesthetic sympathetic blockade (LASB) is a common treatment for complex regional pain syndrome (CRPS). It involves blocking the activity of sympathetic nerves in the spine through the injection of a local anaesthetic drug. This updated review sought to identify the available evidence regarding whether LASB is effective at reducing pain in CRPS, how long any pain relief might last, and whether LASB is safe.

We found a small number of small trials, all of which may be at risk of bias. We did not find evidence that LASB was better than placebo in reducing pain, or that it provided additional pain relief when added to rehabilitation. While a number of small studies compared LASB to other treatments, most did not find that LASB was better than any other intervention. Only five studies reported on adverse events. These studies reported only minor side effects but since most studies did not report this information we can draw no firm conclusions about the safety of LASB.

Overall, while the evidence is very limited and precludes the drawing of strong conclusions, the existing evidence does not provide support for the efficacy of LASB in managing people with CRPS.