A comparison of analgesic efficacy and safety of clonidine and methylprednisolone as additives to 0.25% ropivacaine in stellate ganglion block for the treatment of complex regional pain syndrome: a prospective randomised single blind study

Abstract

Background The role of the sympathetic nervous system appears to be central in causing pain in complex regional pain syndrome (CRPS). The stellate ganglion block (SGB) using additives with local anesthetics is an established treatment modality. However, literature is sparse in support of selective benefits of different additives for SGB. Hence, the authors aimed to compare the efficacy and safety of clonidine with methylprednisolone as additives to ropivacaine in the SGB for treatment of CRPS. Methods A prospective randomized single blinded study (the investigator blinded to the study groups) was conducted among patients with CRPS-I of the upper limb, aged 18–70 years with American Society of Anaesthesiologists physical status I–III. Clonidine (15 μg) and methylprednisolone (40 mg) were compared as additives to 0.25% ropivacaine (5 mL) for SGB. After medical treatment for two weeks, patients in each of the two groups were given seven ultrasound guided SGBs on alternate days. Results There was no significant difference between the two groups with respect to visual analogue scale score, edema, or overall patient satisfaction. After 1.5 months follow-up, however, the group that received methylprednisolone had better improvement in range of motion. No significant side effects were seen with either drug. Conclusions The use of additives, both methylprednisolone and clonidine, is safe and effective for the SGB in CRPS. The significantly better improvement in joint mobility with methylprednisolone suggests that it should be considered promising as an additive to local anaesthetics when joint mobility is the concern.

Efficacy and Safety of Pharmacological Treatment in Patients with Complex Regional Pain Syndrome: A Systematic Review and Meta-Analysis

“…The systematic search identified 1648 articles, of which 23 RCTs with 1029 patients (i.e., 641 females and 388 males) were eligible ( Figure 1 ). All included studies assessed the analgesic effects of pharmacological treatment on CRPS patients via visual analog scale (VAS); among them, BPs (alendronate = 2; clodronate = 1; pamidronate = 2; neridronate = 2) [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ], ketamine (n = 2) [ 18 , 19 ], GCs (prednisolone = 2; methylprednisolone = 3) [ 20 , 21 , 22 , 23 , 24 ], NSAIDs (parecoxib = 2; piroxicam = 1) [ 25 , 26 , 27 ], MgSO4 (n = 2) [ 28 , 29 ], DMSO (n = 2) [ 30 , 31 ], and immunoglobulin (Ig, n = 2) [ 32 , 33 ] were analyzed. As one of the important types of chronic pain, there were 377 patients (9 RCTs included) with CRPS lasting more than one year.…”

“…( A ) A summary table of review authors’ judgements for each risk of bias item for each study. ( B ) A plot of the distribution of review authors’ judgements across studies for each risk of bias item [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

“…Figure 3. Efficacy of pharmacological treatment on long-term pain relief[12,[14][15][16][19][20][21][22][23]28,33].…”

Effect of ultrasound-guided stellate ganglion block on cerebral oxygen metabolism and S100B protein during carotid endarterectomy

“…This study aimed to investigate a feasible and effective method that can activate endogenous neuroprotective mechanisms to prevent perioperative cerebral ischemia-reperfusion injury in CEA. It has been hypothesized by some researchers that intracranial blood vessels are regulated by the autonomic nervous system, and it has been confirmed that SGB can enhance intracranial blood flow and improve cerebral circulation by modulating autonomic nerves [12,13]. Research indicates that SGB can block the conduction of sympathetic ganglionic fibers, preventing intracranial artery spasms, and leading to the dilation of ipsilateral head and neck blood vessels.…”

Complications of ankle arthroscopy: frequency, prevention, and treatment

“…The use of additives, both methylprednisolone and clonidine, was safe and effective for the SGB in CRPS. The significantly better improvement in joint mobility with methylprednisolone suggested that it should be considered promising as an additive to local anaesthetics when joint mobility is the concern ( 45 ).…”