What is the role of a differential neural blockade in the workup of complex regional pain syndrome (CRPS)?

Updated: Nov 08, 2018
  • Author: Steven J Parrillo, DO, FACOEP, FACEP; Chief Editor: Andrew K Chang, MD, MS  more...
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  • Some authors believe that the best diagnostic approach involves use of differential neural blockade. In those with sympathetically mediated pain (as opposed to those whose pain is sympathetically independent), response to neural blockade may help guide medical therapy.

    • For cases involving an upper extremity, a stellate ganglion block may aid the diagnostic process and may be therapeutic. However, failure to relieve pain does not eliminate the diagnosis. [2, 31]

    • Differential blockade has been performed using Bier blocks with a variety of agents, including local anesthetics, bretylium, steroids, ketorolac, reserpine, and guanethidine and clonidine. [31, 36]

    • The rationale for selective neural blockade is to interrupt stimulation to the sympathetic nervous system. Again, this is effective only in those whose pain is sympathetically dependent. [31]

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