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Local anaesthetic sympathetic blockade for complex regional pain syndromeCepeda MS, Carr DB, Lau J
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SummaryLocal anesthetic sympathetic blockade for complex regional pain syndromeThe efficacy of local anesthetic sympathetic blockade for CRPS is unknown. The sympathetic nervous system has been implicated in the pathophysiology of reflex sympathetic dystrophy (RSD) and causalgia which are now conceptualized as variants of a single entity: complex regional pain syndrome (CRPS). Consequently blockade of the sympathetic nervous system is widely used to treat this pain syndrome. The reviewers sought to evaluate the efficacy of sympathetic blockade with local anesthetic. This systematic review reveals the scarcity of published evidence to support the use of local anesthetic sympathetic blockade as the "gold standard" treatment for CRPS and raises questions as to its usefulness.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 4, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 19. 2005 AbstractBackgroundLocal anaesthetic blockade of the sympathetic chain is widely used to treat reflex sympathetic dystrophy (RSD) and causalgia. These two pain syndromes are now conceptualized as variants of a single entity: complex regional pain syndrome (CRPS). A recent meta-analysis of the topic has been published. However, this study only evaluated studies in English language and therefore it could have overlooked some randomized controlled trials. ObjectivesThis systematic review had three objectives: to determine the likelihood of pain alleviation after sympathetic blockade with local anesthetics in the patient with CRPS; to assess how long any benefit persists; and to evaluate the incidence of adverse effects of the procedure. Search strategyWe searched the Cochrane Pain, Palliative and Supportive Care Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, LILACS, and conference abstracts of the World Congresses of the International Association for the Study of Pain. Bibliographies from retrieved articles were also searched for additional studies. Selection criteriaWe considered for inclusion randomized controlled trials (RCTs) that evaluated the effect of sympathetic blockade with local anesthetics in children or in adult patients to treat RSD, causalgia, or CRPS. Data collection and analysisThe outcomes of interest were the number of patients who obtained at least 50% of pain relief shortly after sympathetic blockade (30 minutes to 2 hours) and 48 hours or later. We also assessed the presence of adverse effects in each treatment arm. A random effects model was used to combine the studies. Main resultsTwo small randomized double blind cross over studies that evaluated 23 subjects were found. The combined effect of the two trials produced a relative risk (RR) to achieve at least 50% of pain relief 30 minutes to 2 hours after the sympathetic blockade of 1.17 (95% CI 0.80-1.72). It was not possible to determine the effect of sympathetic blockade on long-term pain relief because the authors of the two studies evaluated different outcomes. Authors' conclusionsThis systematic review revealed the scarcity of published evidence to support the use of local anesthetic sympathetic blockade as the 'gold standard' treatment for CRPS. The two randomized studies that met inclusion criteria had very small sample sizes, therefore, no conclusion concerning the effectiveness of this procedure could be drawn. There is a need to conduct randomized controlled trials to address the value of sympathetic blockade with local anesthetic for the treatment of CRPS. |