title: Use of continuous interscalene brachial plexus block and rehabilitation to treat complex regional pain syndrome of the shoulder.
abstract: OBJECTIVE
  To evaluate the use of continuous interscalene brachial plexus block with bupivacaine to treat complex regional pain syndrome (CRPS) type 1 of the shoulder in adult patients who were refractory to standard therapies.
  
  
  METHODS
  We performed a prospective, cross-sectional study of 59 cases of treatment-refractory CRPS type 1 of the shoulder. The patients were treated with one week of continuous interscalene brachial plexus block with bupivacaine and concomitant rehabilitation in a specialist centre. After withdrawal of the catheter, rehabilitation was continued for a further 3 weeks. The outcomes at 1, 6 and 12 months were evaluated in terms of the Constant score, the verbal numeric rating scale (VNRS) for pain, joint range of motion and medication use. Patients were later interviewed by telephone and asked to state their professional situation, the current VNRS score for pain and the status of their CRPS.
  
  
  RESULTS
  In the first month of treatment, the mean VNRS pain score fell from 7.4 to 3.6, the Constant score rose from 21.7 to 56.6% and the joint range of motion increased from 5.4 to 29.9° for external rotation (ER) position 1 and from 38.6 to 74.2° for abduction. These improvements persisted over time, despite a very slight reduction at 6 months. 86% of the interviewed patients reported that the treatment protocol had improved or greatly improvement their condition. 46% of the respondees had been able to return to work.
  
  
  CONCLUSIONS
  Treatment with a combination of a 1-week continuous interscalene brachial plexus block and rehabilitation may be a good option for patients with CRPS type 1 of the shoulder and who are refractory to standard therapies.
authors.affiliation: CRRF Kerpape, 56275 Ploemeur cedex, France. vdetaille@kerpape.mutualite56.fr
authors.forename: V
authors.initials: V
authors.lastname: Detaille
authors.forename: F
authors.initials: F
authors.lastname: Busnel
authors.forename: H
authors.initials: H
authors.lastname: Ravary
authors.forename: A
authors.initials: A
authors.lastname: Jacquot
authors.forename: D
authors.initials: D
authors.lastname: Katz
authors.forename: G
authors.initials: G
authors.lastname: Allano
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local; D001917:Brachial Plexus; D002045:Bupivacaine; D002408:Catheters, Indwelling; D020918:Complex Regional Pain Syndromes / Q000534:rehabilitation / Q000628:therapy*; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D016059:Range of Motion, Articular; D000070599:Shoulder Injuries
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine