What is the role of sympathetic block in the treatment of complex regional pain syndrome type 1 (CRPS 1) (RSD)?

Updated: Mar 09, 2021
  • Author: T P Sudha Rao, MD; Chief Editor: Herbert S Diamond, MD  more...
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Sympathetic nerve blocks are first-line interventional treatment options for patients with CRPS. Stellate ganglion blocks are used for CRPS of the upper extremities, while lumbar sympathetic blocks are used for CRPS of the lower extremity. [17]

For CRPS affecting an upper extremity, inject a local anesthetic into the stellate and upper dorsal sympathetic ganglia to block the efferent sympathetic impulses from the involved extremity. Lidocaine or bupivacaine, with or without epinephrine, is usually used. Guanethidine has been used, but was found to be no more effective than placebo, and was associated with significant adverse effects. [18]

This procedure warms the skin, inhibits sweating, and causes flushing. A successful blockade is indicated by the development of ipsilateral Horner syndrome, ie, ptosis, miosis, and enophthalmos.

Symptoms usually abate within 30 minutes, confirming the diagnosis. Once adequate blockade has been achieved, ensure that the patient participates in hand therapy. Although the interruption lasts only a few hours, the benefits may persist for several days.

Use 1-2 blocks per week. An average of 4-5 blocks is required to permanently relieve symptoms. For symptoms that are not adequately relieved after 4-5 blocks, institute a continuous stellate blockade via a subcutaneously placed catheter or conduct an operative sympathectomy.

For lower-extremity CRPS, a lumbar block is used.

A systematic review found insufficient evidence to draw firm conclusions regarding the efficacy or safety of sympathetic blockade with local anesthetic, but determined that the limited data available do not suggest the technique is effective for reducing pain in CRPS. [19]

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