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.

Author(s): Toshniwal G, Sunder R, Thomas R, Dureja GP

Affiliation(s): Department of Anesthesiology, Wayne State University/Detroit Medical Center, Detroit, Michigan Department of Biostatistics, Children's Hospital of Michigan, Detroit Medical Center, Detroit, Michigan, USA Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi Delhi Pain Management Center and Department of Pain Medicine, Indian Spinal Injuries Center, New Delhi, India.

Publication date & source: 2011-12-05, Pain Med., [Epub ahead of print]

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. Wiley Periodicals, Inc.