The treatment of complex regional pain syndrome (CRPS) involving upper extremity with continuous sensory analgesia

Abstract

Continuous sensory analgesia of brachial plexus (CSA BP) was only occasionally reported to have been used in the treatment of CRPS. In the past four years, we have treated 21 patients with a working diagnosis of CRPS. The treatment was instituted one to six months after inciting injury. All patients were admitted to hospital. In the first two days, the therapy consisted of elevation, cryotherapy, and active exercises. Five patients responded well to this initial physiotherapy (5/21). In 16 cases, no evident improvement was observed and CSA BP was introduced. At follow-up (3-36 months), the results were: 13/16 (81%) had at least good results (excellent 2, good without any sequelae 5, good with sequelae of initial injury 6, and poor 3). The results were judged as follows: excellent (completely normal hand); good (only temporary pain up to 2 on a 0-10 numeric rating scale; no signs of dysfunction of sympathetic nervous system; ROM of wrist over 50% of normal hand; ROM of fingers excellent or good; and the strength of hand grasp and key pinch over 50% of normal hand measured with dynamometer) and if any of the former criteria was missing, the result was defined as poor.

Efficacy of adjuvant dexmedetomidine in supraclavicular brachial plexus block for intractable complex regional pain syndrome: A case report with a 3‐year follow‐up

“…Complex regional pain syndrome (CRPS) is characterized by intense sensory, autonomic, motor and trophic changes, which are not commensurate with the inciting event and cannot be accounted for by other causes of chronic pain . Somatic block, sympathetic block and other methods of neuromodulation have been used for treatment, with varying degrees of efficacy . The brachial plexus block (BPB) and stellate ganglion block (SGB) have been shown to improve pain in upper‐limb CRPS, albeit transiently .…”

“…Due to the complex mechanism involved, no guidelines have been reported for successful control of CRPS pain. In addition to systemic analgesics, nerve blocks are frequently used as a part of the multidisciplinary management for improving pain by suppressing ectopic impulse generators in the injured nerve with the local anaesthetics …”

“…1 Somatic block, sympathetic block and other methods of neuromodulation have been used for treatment, with varying degrees of efficacy. [2][3][4][5] The brachial plexus block (BPB) and stellate ganglion block (SGB) have been shown to improve pain in upper-limb CRPS, albeit transiently. 3,4,6 Continuous infusion of an injectate via a catheter or the use of various additives, such as opioids, clonidine, neostigmine and tramadol, has been explored to prolong the duration of analgesia, but the available evidence is limited.…”

“…[2][3][4][5] The brachial plexus block (BPB) and stellate ganglion block (SGB) have been shown to improve pain in upper-limb CRPS, albeit transiently. 3,4,6 Continuous infusion of an injectate via a catheter or the use of various additives, such as opioids, clonidine, neostigmine and tramadol, has been explored to prolong the duration of analgesia, but the available evidence is limited. 6,7 Toshiniwal et al reported that continuous administration of local anaesthetics via the BPB or SGB over 1 week resulted in significant reduction in the intensity of CRPS limb pain at 4 weeks, but did not report the long-term follow-up outcomes.…”

Peripheral catheter techniques

“…Several case reports on adults have emphasized the importance of repetition blocks or the establishment of perineural catheters for controlling pain and improving the treatment for CRPS (58–60). The keys to success are active physiotherapy treatment and restoration of normal limb movement (61), to which CPNB may contribute.…”