Successful management of complex regional pain syndrome type 1 using single injection interscalene brachial plexus block

Fallatah, Summayah

doi:10.4103/1658-354x.140903

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…Brachial plexus block is used for regional anesthesia during upper extremity surgery (arm, elbow, forearm, wrist, and hand) [ 35 ]. In chronic pain management, ultrasound-guided hydrodissection of the brachial plexus has been used to treat severe neck sprains (brachial plexus injury without rupture; it is only used to treat neuropraxia with or without axonotmesis) with radiating pain to the ipsilateral upper limb [ 36 ], CRPS [ 37 ] involving the ipsilateral upper limb, and thoracic outlet syndrome or other double/triple crush syndromes involving the ipsilateral upper limb [ 38 ].…”

Section: Methodsmentioning

confidence: 99%

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

Lam

Reeves

Cheng

2017

BioMed Research International

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Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of 16 ± 12.2 months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of 8.3 ± 1.3. The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1% ± 9.8%. The pretreatment Numeric Pain Rating Scale score of 8.3 ± 1.3 improved to 1.9 ± 0.9 at 2 months after the last treatment. Patients received 3.8 ± 2.6 treatments over 9.7 ± 7.8 months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.

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Section: Methodsmentioning

confidence: 99%

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

Lam

Reeves

Cheng

2017

BioMed Research International

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“…Medical treatments can also classify the pain: stellate ganglion blocks will only relieve CRPS [6, 100,101]. Other therapies for CRPS include botulinum toxin, which can be used to treat muscular trigger points [102] when found, and electroacupuncture, which has been found effective in controlling experimental brachial plexus pain in rats [103]. We have not found any publication reporting the use of electroacupuncture in human beings.…”

Section: Medical Treatmentmentioning

confidence: 99%

“…CRPS is the exception as further surgery outside trapped nerve decompression seems to have a negative impact on the outcome [101]. In these cases either an interscalene [102] or stellate ganglion block [110] or a cervical spinal cord stimulator [111][112][113] is recommended instead. The phantom limb pain only improves with central nervous system procedures [114,115].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Saiz-Sapena¹,

Vanaclocha‐Vanaclocha²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Brachial plexus injuries are commonly followed by chronic pain, mostly with neuropathic characteristics. This is due to peripheral nerve lesions, particularly nerve root avulsions, as well as upper limb amputations, and complex regional pain syndrome (CRPS). The differential diagnosis between CRPS and neuropathic pain is essential as the treatment is different for each of them. Medical treatments are the first step, but for refractory cases there are two main types of surgical alternatives: ablative techniques and neuromodulation. The first group involves destruction of the posterior horn deafferented neurons and usually provides a better pain control but has a 10% complication rate. The second group provides pain control with function preservation but with limited effectiveness. Each case has to be thoroughly evaluated to apply the treatment modality best suited for it. due to iatrogenia [8][9][10][11][12][13][14][15][16], particularly during lymph node biopsy [17, 18] or treatment of some malignancies [19]. The pain is chronic [20], persistent [7], constant [21], burning [22] and throbbing [17], with paroxysmal discharges [3, 6, 23], particularly upon gentle rubbing the affected area [4].The pain is distributed in the distal areas of the upper limb, covering several dermatomes, mostly the caudal ones [24] and particularly the hand [5, 17, 23, 25]. The paroxysmal pain is felt in the arm [26]. Allodynia, hypersensitivity and electric-like discharges are present at the border between the normal and affected dermatomes [17,[26][27][28][29], particularly between T 1 and T 2 at the posterior aspect of the elbow [26].The pain severity correlates with the magnitude of the brachial plexus injury [2,3] and to the number of avulsed nerve roots [2-4, 21, 26, 30-33], particularly when the lower roots are affected [24,34,35]. Nevertheless, Bertelli et al. [21] found that in isolated C 8 and T 1 nerve root avulsions, there was no pain at all.The pain does not appear immediately after the injury but a few days later [24] and no longer than 3 months after it [5, 6, 24, 26,35,36].The neuropathic pain can be associated with phantom [37] or stump pain [38] in case of upper limb amputation, or to complex regional pain syndrome (CRPS) [6], inducing a complex pain condition rather difficult to control [19,30,31].Self-mutilation has been described in 5-29% of obstetric brachial plexus injury cases [39,40].The quality of life is seriously impaired with sleep disorders, family troubles, unemployment, chronic depression and social withdrawal [2, 5, 6, 17, 21,[41][42][43][44]. Additionally, the chronic pain is a further hindrance to comply with a good rehabilitation programme, impairing a possible functional recovery [6,45,46]. Among all the disabilities induced by the brachial plexus injury, the pain has been found to be the symptom that most negatively affects the quality of life [47].Treatment of this chronic pain can be troublesome, as the response to the different treatment modalities is poor and not all of them allow preservatio...

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“…A sonographically assisted interscalene brachial plexus block (single injection of 30 ml, 0.25 % bupivacaine) resulted in immediate pain relief and gradual functional recovery. At 3-months follow-up the patient showed complete pain relief and normal limb function [7]. Wang et al (2001) reported the case of a 32-year-old man suffering from acute CRPS in his right upper limb following carpal tunnel release.…”

Section: Discussionmentioning

confidence: 97%

Pain control in chronic, refractory CRPS by continuous brachial plexus analgesia

Żyluk

Puchalski

2018

Handchir Mikrochir plast Chir

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Each patient underwent a mean of 4.4 (range 2-8) spinal catheter implantations. A rapid and strong analgesic effect was observed immediately after the injection of bupivacaine solution was started: Pain decreased from a mean of 8.3 to 1.6. The duration of maintaining the catheter in the brachial plexus and achieving effective analgesia was 5.3 months (range 2-12). After the removal of the catheter, the pain returned to baseline. No patient achieved a permanent, or at least partial, reduction of pain after completing this therapy.

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Successful management of complex regional pain syndrome type 1 using single injection interscalene brachial plexus block

Cited by 10 publications

References 16 publications

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

Treatment of Neuropathic Pain in Brachial Plexus Injuries

Pain control in chronic, refractory CRPS by continuous brachial plexus analgesia

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