title: Management of complex regional pain syndrome type I in upper extremity-evaluation of continuous stellate ganglion block and continuous infraclavicular brachial plexus block: a pilot study.
abstract: Interventional pain management techniques play an important role in the multidisciplinary approach to management of complex regional pain syndrome (CRPS). In this preliminary study we compared the efficacy of continuous stellate ganglion (CSG) block with that of continuous infraclavicular brachial plexus (CIBP) block in management of CRPS type I of upper extremity.
  
  
  METHODS
  Thirty-three patients with CRPS type I of upper extremity were randomly assigned to either CSG or CIBP group. Patients were treated for 1 week with continuous infusion of 0.125% bupivacaine at 2and 5mL/h, respectively. Catheter was removed at 1 week and patients were followed up for 4 weeks. The outcome was evaluated in terms of neuropathic pain scale score (NPSS), edema scores (Grades 0-2), and range of motion (ROM) of all upper extremity joints (Grades 0-2).
  
  
  RESULTS
  CIBP group showed statistically significant improvement in NPSS compared with CSG group during the first 12 hours after the procedures (P value <0.05). After 12 hours, the NPSS was comparable between the groups. At 4 weeks, both groups showed clinically significant improvement in edema score and ROM of all upper extremity joints when compared with the baseline.
  
  
  CONCLUSIONS
  This preliminary study suggests that CIBP block and CSG block may be feasible and effective interventional techniques for the management of CRPS type I of upper extremities. Hence, we recommend a larger well-randomized, well-controlled, clinical trial to confirm our findings and determine if any significant difference exists between the groups in terms of long-term pain relief and functional restoration.
authors.affiliation: Department of Anesthesiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA. grtosh1@gmail.com
authors.forename: Gokul
authors.initials: G
authors.lastname: Toshniwal
authors.forename: Rani
authors.initials: R
authors.lastname: Sunder
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: G P
authors.initials: GP
authors.lastname: Dureja
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001340:Autonomic Nerve Block / Q000379:methods*; D001917:Brachial Plexus / Q000187:drug effects* / Q000502:physiology; D002045:Bupivacaine / Q000008:administration & dosage; D002968:Clavicle / Q000187:drug effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010865:Pilot Projects; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy* / Q000503:physiopathology; D013233:Stellate Ganglion / Q000187:drug effects* / Q000502:physiology; D034941:Upper Extremity; D055815:Young Adult
chemical_list: D002045:Bupivacaine