scholarly journals RE: “A Prospective, Randomized Cross-Over Trial of T2 Paravertebral Block as a Sympathetic Block in Complex Regional Pain Syndrome (CRPS)”

2020 ◽  
Vol 6;23 (11;6) ◽  
pp. E733
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Paravertebral Block ◽  
Sympathetic Block

scholarly journals A Prospective, Randomized Cross-Over Trial of T2 Paravertebral Block as a Sympathetic Block in Complex Regional Pain Syndrome

2019 ◽  
Vol 5 (22;5) ◽  
pp. E417-E424
Author(s):  
Eung Don Kim
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Upper Extremity ◽  
Primary Outcome ◽  
Stellate Ganglion ◽  
Stellate Ganglion Block ◽  
Pain Syndrome ◽  
Paravertebral Block ◽  
Sympathetic Block ◽  
Ganglion Block ◽  
Patient Satisfaction Scores

Background: Sympathetic block is commonly performed in clinical practice for management of intractable pain conditions. However, stellate ganglion block (SGB) alone often does not achieve sufficient sympatholysis of the upper extremity. The paravertebral space continues up to the cervical sympathetic chain and includes the stellate ganglion. We compared the sympatholytic and analgesic effect of paravertebral block performed at the T2 level (T2 PVB) with that of SGB in patients with complex regional pain syndrome (CRPS) of the upper extremity. Objectives: The aim of this study was to compare the sympatholytic property of T2 PVB with that of the conventional SGB in patients with CRPS of the upper extremity. Study Design: Prospective, randomized cross-over trial. Setting: University hospital pain center in Korea. Methods: Fifteen patients with upper extremity CRPS were randomly assigned to 1 of 2 intervention methods (SGB or T2 PVB). After effects of the first block receded, the patients were crossed over to the second procedure. A difference in temperature increase between the treated side and the opposite side (ΔT) ≥ 1.5°C was considered as a successful primary outcome. Rate of successful primary outcome, degree of pain reduction, duration of effect, and patient satisfaction scores were compared between the 2 intervention methods. Results: Rate of successful primary outcome (ΔT ≥ 1.5°C) was significantly higher in the T2 PVB cases than in the SGB cases (80.0% vs. 20.0%; P = 0.003). Numeric Rating Scale scores after the procedure were significantly lower in the T2 PVB group. Patient satisfaction scores were significantly higher, and the duration of the block was significantly longer in the T2 PVB cases than in the SGB cases. Limitations: The relatively small sample size from a single center, and the lack of standardization of the injected volume of T2 PVB and SGB were limitations. Conclusions: T2 PVB showed superior sympatholytic effect than SGB; other clinical outcomes were also better with T2 PVB than with SGB. T2 PVB can be a useful option for producing sympatholytic and analgesic effect in patients with CRPS of the upper extremity. Key words: Sympathetic block, Complex Regional Pain Syndrome, paravertebral block, stellate ganglion block

Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: A double-blind randomized controlled study

Pain ◽  
2014 ◽  
Vol 155 (11) ◽  
pp. 2274-2281 ◽  
Author(s):  
Roberto de Oliveira Rocha ◽  
Manoel Jacobsen Teixeira ◽  
Lin Tchia Yeng ◽  
Mirlene Gardin Cantara ◽  
Viviane Gentil Faria ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Type I ◽  
Syndrome Type ◽  
Sympathetic Block ◽  
Double Blind ◽  
Randomized Controlled

PAIN SYNDROMES AFTER MISSILE-CAUSED PERIPHERAL NERVE LESIONS

Neurosurgery ◽  
2006 ◽  
Vol 59 (6) ◽  
pp. 1226-1237 ◽  
Author(s):  
Zoran Roganovic ◽  
Gordana Mandic-Gajic
Keyword(s):  
Pain Intensity ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Diagnostic Procedures ◽  
Syndrome Type ◽  
Type Ii ◽  
Sympathetic Block ◽  
Pain Syndromes ◽  
Neuralgic Pain ◽  
Symptoms And Signs

Abstract OBJECTIVE To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries. METHODS The prospective study included 326 patients with clinically significant pain syndromes including complex regional pain syndrome Type II, deafferentation pain, reinnervation pain, and neuralgic pain. Diagnostic procedures were analyzed, factors influencing the pain intensity were identified, and the patients' characteristics, pain characteristics, and other clinical symptoms and signs were compared between different types of pain syndromes. RESULTS The rate of painful injuries ranged from 17.3 to 22.9% for mixed nerves and from 2.6 to 4.6% for motor nerves. Peripheral nerve block and sympathetic block were useful and safe adjuvant diagnostic procedures, obtaining pain relief in 66.7% of patients with neuralgic pain and in 90.1% of patients with complex regional pain syndrome Type II. Pain started 2.6 days after injury in patients with complex regional pain syndrome Type II and 11.9 days after injury in patients with painful nerve adhesions (analysis of variance, P< 0.001). Permanent pain was more frequent (79.1%) than paroxysmal pain, superficial pain was more frequent (55.2%) than deep pain, and burning pain was the most frequent pain descriptor (43.6%). Ten factors were found to significantly influence the pain intensity (binary logistic analysis), including three independent predictors (multivariate analysis): type of pain syndrome (P< 0.001), multiple nerve damage in the injury site (P= 0.022), and onset of pain in the first two days after injury (P= 0.031). CONCLUSION Pain syndromes after missile-caused nerve injury differ significantly regarding time of pain onset, pain characteristics, and other symptoms and signs. The type of pain syndrome, multiple nerve damage, and early onset of pain are independent predictors of initial pain intensity. Although medical history and physical examination are the main diagnostic keys, nerve exploration preceded by a nerve block and sympathetic block are safe and useful adjuvant diagnostic procedures.

scholarly journals Continuous Thoracic Sympathetic Ganglion Block in Complex Regional Pain Syndrome Patients with Spinal Cord Stimulation Implantation

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
EungDon Kim ◽  
MiSun Roh ◽  
SooHyang Kim ◽  
DaeHyun Jo
Keyword(s):  
Spinal Cord ◽  
Complex Regional Pain Syndrome ◽  
Spinal Cord Stimulation ◽  
Sympathetic Ganglion ◽  
Pain Syndrome ◽  
Term Effect ◽  
Sympathetic Block ◽  
Short Term ◽  
Ganglion Block ◽  
Ischemic Disease

The sympathetic block is widely used for treating neuropathic pain such as complex regional pain syndrome (CRPS). However, single sympathetic block often provides only short-term effect. Moreover, frequent procedures for sympathetic block may increase the risk of complications. The use of epidural route may be limited by concern of infection in case of previous implantation of the spinal cord stimulation (SCS). In contrast, a continuous sympathetic block can be administered without such concerns. The continuous thoracic sympathetic block (TSGB) has been used to treat the ischemic disease and other neuropathic conditions such as postherpetic neuralgia. We administered continuous thoracic sympathetic block using catheter in CRPS patients who underwent SCS implantations and achieved desirable outcomes. We believe a continuous sympathetic block is a considerable option before performing neurolysis or radiofrequency rhizotomy and even after SCS implantation.

scholarly journals Intravenous Regional Sympathetic Block: Past, Present and Future?

2004 ◽  
Vol 9 (1) ◽  
pp. 35-37 ◽  
Author(s):  
Alfred PJ Lake
Keyword(s):  
Clinical Trials ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Supporting Evidence ◽  
Syndrome Type ◽  
Sympathetic Block

Intravenous regional sympathetic block is a valued component of the pain clinician's armamentarium for the management of the complex regional pain syndrome type 1. Treatment of this multifaceted condition is multimodal, and despite a lack of convincing supporting evidence from clinical trials, the author makes the case for retaining the technique while recommending both appropriate guidance and further study.

scholarly journals Sympathetic block with botulinum toxin to treat complex regional pain syndrome

2009 ◽  
Vol 65 (3) ◽  
pp. 348-351 ◽  
Author(s):  
Ian Carroll ◽  
J. David Clark ◽  
Sean Mackey
Keyword(s):  
Botulinum Toxin ◽  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Sympathetic Block

scholarly journals Lumbar Sympathetic Block with Botulinum Toxin Type B for Complex Regional Pain Syndrome: A Case Study

2015 ◽  
Vol 5;18 (5;9) ◽  
pp. E911-E916 ◽  
Author(s):  
Francis Sahngun Nahm
Keyword(s):  
Botulinum Toxin ◽  
Complex Regional Pain Syndrome ◽  
Skin Color ◽  
Pain Syndrome ◽  
Sympathetic Nerves ◽  
Botulinum Toxin Type ◽  
Sympathetic Ganglia ◽  
Sympathetic Block ◽  
Type B ◽  
Botulinum Toxin Type B

Lumbar sympathetic block (LSB) is an effective method for relief of sympathetically mediated pain in the lower extremities. To prolong the sympathetic blockade, sympathetic destruction with alcohol or radiofrequency has been used. The preganglionic sympathetic nerves are cholinergic, and botulinum toxin (BTX) has been found to inhibit the release of acetylcholine at the cholinergic nerve terminals. Moreover, BTX type B (BTX-B) is more convenient to use than BTX type A. Based on these findings, we performed LSB on the 2 patients with complex regional pain syndrome (CRPS) in the lower extremity. Levobupivacaine 0.25% 5 mL mixed with BTX-B 5,000 IU was given under fluoroscopic guidance. Two months after LSB with BTX-B, pain intensity and the Leeds assessment of neuropathic symptoms and signs (LANSS) score were significantly reduced. Allodynia and coldness disappeared and skin color came back to normal. In conclusion, BTX-B can produce an efficacious and durable sympathetic blocking effect on patients with CRPS. Key words: Botulinum toxins, complex regional pain syndrome, chemical sympathectomy, sympathetic ganglia

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