The American Academy of Pain Medicine      Annual Meeting Home Page     
23rd Annual Meeting
February 7-10, 2007
New Orleans, LA

© 2006 American Academy of Pain Medicine
 


Thursday, February 8, 2007
100

Management of Complex Regional Pain Syndrome Type I in Upper Limb – Evaluation of Continuous Infraclavicular Brachial Plexus Block and Continuous Stellate Ganglion Block with Bupivacaine

Gokul Toshniwal, M.B, B.S1, G. P. Dureja, M.D2, Jayalakshmi S1, and Rani Sunder1. (1) All India Institute of Medical Sciences, New Delhi, India, (2) Indian Spinal Injuries Center,, New Delhi, India

Introduction: Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome(1). Continuous Stellate Ganglion (CSG) block has proven its efficacy in the management of CRPS in upper limb(2). Continuous Brachial Plexus block has also been used, which act by blocking both sympathetic and somatic innervation(3). This study aims to compare the efficacy and feasibility of Continuous Infraclavicular Brachial Plexus (CIBP)and CSG in CRPS Type I in upper limb with bupivacaine. Methods and Materials: In this randomized, prospective, non-blinded study, 30 patients were enrolled after institutional ethical committee approval. CSG block was given through a 20G IV cannula and CIBP block was given through contiplex catheter. After the procedure all patients were observed for 24hrs and then send home with the catheter insitu. 0.125% bupivacaine was delivered by means of a rate specific ambulatory elastomeric pump attached to the catheters. In first 24 hrs patient was assessed at 6min, 30min, 2hr, 12hr and 24 hr and after 24hrs all patients were assessed every day for 1 week and then every week for 1 month for VAS, Neuropathic Pain Scale Score (NPSS), Plethysmography, Telethermometry, Edema score, Range of motion. Results: There was no statistical difference in demographic data. Sympatholysis was comparable in both groups. The peak onset of action in CSG group was at around 12hrs and in CIBP group it was as early as 30minutes. There was statistically significant decrease in pain scores with time within the group. Patients in CIBP showed clinically significant improvement in the range of motion in the distal joints. Conclusion: We concluded that both CSG block and CICBP block using ambulatory infusion pump are feasible procedures and offer comparable long term pain relief and functional restoration. Patients who received CICBP block showed fast track recovery and provided an ideal condition for initiating aggressive physiotherapy.

References: 1. Micheal Stanton – Hicks etal. Consensus report – Complex Regional Pain Syndrome. Guideline for therapy. Clin J Pain, 1998: 14; 155-66. 2. Geraci etal. Continuous stellate ganglion block. Anesthesiology, 1967: 28; 632. 3. Murray etal. Continuous axillary brachial plexus blockade for reflex sympathetic dystrophy. Anesthesia, 1995: 50; 633-35.


Funding: None

Gokul Toshniwal, M.B, B.S
Nothing to disclose.