title: Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim.
abstract: OBJECTIVE
  This preliminary and retrospective pilot case series examines a treatment concept consisting of ultrasound-guided stellate ganglion blocks (SGBs) combined with pharmacological and occupational therapy in patients with complex regional pain syndrome (CRPS) of the hand. Efficacy of combined treatment concepts and safety of ultrasound-guided SGB have not been sufficiently investigated yet.
  
  
  METHODS
  A total number of 156 blocks were evaluated in 16 patients with CRPS in a retrospective analysis. All patients received pharmacotherapy and a standard regimen of occupational therapy offered simultaneously to the SGBs. Changes in both spontaneous and evoked pain levels were assessed by numerical pain rating score before and after the last blockade of a series. Side effects were documented.
  
  
  RESULTS
  The overall mean pain reduction was 63.2% regarding spontaneous and 45.3% regarding evoked pain. Mild complications, such as hoarseness or dysphagia, occurred in 13.5% of the blocks (21 SGBs). Serious complications, such as plexus paresis or accidental puncture of vessels or other structures, did not occur. Time between symptom onset and start of treatment did not affect the extent of pain reduction.
  
  
  CONCLUSIONS
  The combination of ultrasound-guided SGB and simultaneous pharmacological and occupational therapy showed encouraging treatment results under conditions of this pilot case series. Assessment of efficacy of this combined treatment concept and safety of ultrasound-guided SGB require further prospective clinical studies with larger number of participants.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Wei
authors.forename: Robert E
authors.initials: RE
authors.lastname: Feldmann
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Brascher
authors.forename: Justus
authors.initials: J
authors.lastname: Benrath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001340:Autonomic Nerve Block / Q000379:methods*; D020918:Complex Regional Pain Syndromes / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D009788:Occupational Therapy / Q000379:methods*; D010147:Pain Measurement / Q000379:methods*; D010865:Pilot Projects; D012189:Retrospective Studies; D013233:Stellate Ganglion / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography
keywords: CRPS; Outcome Assessment; Pain Management; Safety; Ultrasound