Neural modulation by blocks and infusions.
Neural blockade is widely used in clinical practice to alleviate acute or chronic pain, including neuropathic pain. However, to date there is little controlled evidence to confirm the efficacy of nerve blocks in neuropathic pain. The most common indication for nerve blocks, especially sympathetic blockade, is complex regional pain syndrome, in which success rates of up to 38% have been achieved, depending on the type of the block used. Greater efficacy has been achieved by combining a nerve block with patient-controlled analgesia. Sympathectomy is recommended for the treatment of neuropathic pain only after careful consideration of its usefulness, effectiveness, and risk of adverse effects. Current evidence and clinical experience suggest that neural blockade could be a useful adjunct in the management of refractory neuropathic pain, but further well-controlled studies would be of great benefit to support this type of therapy.
Varrassi
Giustino
G
Department of Anesthesiology and Pain Management, University of L'Aquila, L'Aquila, Italy. giuvarr@tin.it
Paladini
Antonella
A
Marinangeli
Franco
F
Racz
Gabor
G
D000779:Anesthetics, Local / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000379:methods / Q000639:trends; D006801:Humans; D036502:Infusions, Intralesional / Q000379:methods / Q000639:trends; D009407:Nerve Block / Q000379:methods* / Q000639:trends; D009437:Neuralgia / Q000188:drug therapy* / Q000503:physiopathology; D010148:Intractable Pain / Q000188:drug therapy* / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy* / Q000503:physiopathology; D012651:Self Medication / Q000379:methods / Q000639:trends; D013562:Sympathectomy / Q000379:methods / Q000639:trends; D016896:Treatment Outcome
D000779:Anesthetics, Local