Presentations: This study was presented in American Academy of Pain Medicine (AAPM) Annual Meeting 2007, New Orleans, LA.
Management of Complex Regional Pain Syndrome Type I in Upper Extremity—Evaluation of Continuous Stellate Ganglion Block and Continuous Infraclavicular Brachial Plexus Block: A Pilot Study
Version of Record online: 5 DEC 2011
Wiley Periodicals, Inc.
Volume 13, Issue 1, pages 96–106, January 2012
How to Cite
Toshniwal, G., Sunder, R., Thomas, R. and Dureja, G. P. (2012), Management of Complex Regional Pain Syndrome Type I in Upper Extremity—Evaluation of Continuous Stellate Ganglion Block and Continuous Infraclavicular Brachial Plexus Block: A Pilot Study. Pain Medicine, 13: 96–106. doi: 10.1111/j.1526-4637.2011.01285.x
- Issue online: 10 JAN 2012
- Version of Record online: 5 DEC 2011
- Sympathetic Block;
- Nerve Block;
- Pain Management;
- Physical Therapy
Interventional pain management techniques play an important role in the multidisciplinary approach to management of complex regional pain syndrome (CRPS). In this preliminary study we compared the efficacy of continuous stellate ganglion (CSG) block with that of continuous infraclavicular brachial plexus (CIBP) block in management of CRPS type I of upper extremity.
Methods. Thirty-three patients with CRPS type I of upper extremity were randomly assigned to either CSG or CIBP group. Patients were treated for 1 week with continuous infusion of 0.125% bupivacaine at 2 and 5 mL/h, respectively. Catheter was removed at 1 week and patients were followed up for 4 weeks.
The outcome was evaluated in terms of neuropathic pain scale score (NPSS), edema scores (Grades 0–2), and range of motion (ROM) of all upper extremity joints (Grades 0–2).
Results. CIBP group showed statistically significant improvement in NPSS compared with CSG group during the first 12 hours after the procedures (P value <0.05). After 12 hours, the NPSS was comparable between the groups. At 4 weeks, both groups showed clinically significant improvement in edema score and ROM of all upper extremity joints when compared with the baseline.
Conclusion. This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration.