title: CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb.
abstract: OBJECTIVE
  To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb.
  
  
  METHODS
  Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was ≥50 %, lasting for at least 2 years.
  
  
  RESULTS
  Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76.
  
  
  CONCLUSIONS
  CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade.
  
  
  CONCLUSIONS
  • Complex regional pain syndrome is painful, disabling and often refractory to treatment. • Sixty-seven percent of patients had lasting pain relief (2 years) after radiofrequency neurolysis. • Retrospective study showed a significantly higher success rate for radiofrequency neurolysis. • CT guidance is mandatory for a successful and safe procedure.
authors.affiliation: Radiology Department, University Hospital CHU Gabriel Montpied, 63000 Clermont-Ferrand, France. adriankastler@gmail.com
authors.forename: Adrian
authors.initials: A
authors.lastname: Kastler
authors.forename: Sébastien
authors.initials: S
authors.lastname: Aubry
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sailley
authors.forename: Demosthene
authors.initials: D
authors.lastname: Michalakis
authors.forename: Gaye
authors.initials: G
authors.lastname: Siliman
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gory
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Lajoie
authors.forename: Bruno
authors.initials: B
authors.lastname: Kastler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000777:Anesthetics / Q000008:administration & dosage*; D017115:Catheter Ablation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D012019:Reflex Sympathetic Dystrophy / Q000175:diagnosis / Q000628:therapy*; D013233:Stellate Ganglion / Q000000981:diagnostic imaging* / Q000187:drug effects*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics