For the integrated multidisciplinary approach to patient care

Return to the Southern Medical Journal

Current User S2 Access Level: -1 ()
CAN NOT ACCESS LEVEL 2
Original Article

Efficacy of Stellate Ganglion Blockade for the Management of Type 1 Complex Regional Pain Syndrome

William E. Ackerman, III, MD, Jun-Ming Zhang, MSc, MD
Volume: 99 Issue: 10 October, 2006

Abstract:

Introduction: The purpose of this study was to examine the efficacy of stellate ganglion blockade (SGB) in patients with complex regional pain syndromes (CRPS I) of their hands.


Methods: After IRB approval and patient informed consent, 25 subjects, with a clinical diagnosis of CRPS I of one hand as defined by the International Association for the Study of Pain (IASP) criteria, had three SGB's performed at weekly intervals. Laser Doppler fluxmetric hand perfusion studies were performed on the normal and CRPS I hands pre- and post-SGB therapy. No patient was included in this study if they used tobacco products or any medication or substance that could affect sympathetic function. The appropriate parametric and nonparametric data analyses were performed and a p value <0.05 was used to reject the null hypothesis.


Results: Symptom onset of CRPS I until the initiation of SGB therapy ranged between 3 to 34 weeks. Following the SGB series, patient pain relief was as follows: group I, 10/25 (40%) had complete symptom relief; group II, 9/25 (36%) had partial relief and group III, 6/25 (24%) had no relief. The duration of symptoms until SGB therapy was: group I, 4.6 ± 1.8 weeks, group II, 11.9 ± 1.6 weeks and group III, 35.8 ± 27 weeks. Compared with the normal control hand, the skin perfusion in the CRPS I affected hand was greater in group I and decreased in groups II and III.


Discussion: The results of our study demonstrate that an inverse relationship exists between hand perfusion and the duration of symptoms of CRPS I. On the other hand, a positive correlation exists between SGB efficacy and how soon SGB therapy is initiated. A duration of symptoms greater than 16 weeks before the initial SGB and/or a decrease in skin perfusion of 22% between the normal and affected hands adversely affects the efficacy of SGB therapy.


Key Points


* An inverse relationship exists between hand perfusion and the duration of symptoms of type 1 complex regional pain syndrome.


* A positive correlation exists between stellate ganglion block efficacy and how soon stellate ganglion block therapy is initiated.


* A duration of symptoms greater than 16 weeks before the initial satellite ganglion block (SGB) and/or a 22% decrease in skin perfusion between the normal and affected hands adversely affects the efficacy of SGB therapy.

Article:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Member Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Images:

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Member Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

References:

1. Drummond PD, Finch PM, Skipworth S, et al. Pain increases during sympathetic arousal in patients with complex regional pain syndrome. Neurology 2001;57:1296–1303.
 
2. Ramer MS, Bisby MA. Adrenergic innervation of rat sensory ganglia following proximal or distal painful sciatic neuropathy: distinct mechanisms revealed by anti-NGF treatment. Eur J Neurosci1999;11:837–846.
 
3. Bennett GJ, Ochoa JL. Thermographic observations on rats with experimental neuropathic pain. Pain1991;45:61–67.
 
4. Chung K, Lee BH, Yoon YW, et al. Sympathetic sprouting in the dorsal root ganglia of the injured peripheral nerve in a rat neuropathic pain model. J Comp Neurol 1996;376:241–252.
 
5. McLachlan EM, Janig W, Devor M, et al. Peripheral nerve injury triggers noradrenergic sprouting within dorsal root ganglia. Nature 1993;363:543–546.
 
6. Ramer MS, Bisby MA. Adrenergic innervation of rat sensory ganglia following proximal or distal painful sciatic neuropathy: distinct mechanisms revealed by anti-NGF treatment. Eur J Neurosci1999;11:837–846.
 
7. Zhang J-M, Li H, Munir MA. Decreasing sympathetic sprouting in pathologic sensory ganglia: a new mechanism for treating neuropathic pain using PubMed | CrossRef
 
8. Stanton-Hicks M, Janig W, Hassenbusch S, et al. Reflex sympathetic dystrophy: changing concepts and taxonomy.[comment]. Pain 1995;63:127–133.
 
9. Ackerman WE 3rd, Ahmad M. Physiologic effects of stellate ganglion block: a result of complete ganglion blockade or the vertical spread of local anesthetic? J Ark Med Soc 2000;96:346–348.
 
10. Delius W, Hagbarth KE, Hongell A, et al. Manoeuvres affecting sympathetic outflow in human skin nerves. Acta Physiol Scand 1972;84:177–186.
 
11. Delius W, Kellerova E. Reactions of arterial and venous vessels in the human forearm and hand to deep breath or mental strain. Clin Sci 1971;40:271–282.
 
12. Hallin RG, Torebjork HE. Single unit sympathetic activity in human skin nerves during rest and various manoeuvres. Acta Physiol Scand 1974;92:303–317.
 
13. Cepeda MS, Lau J, Carr DB. Defining the therapeutic role of local anesthetic sympathetic blockade in complex regional pain syndrome: a narrative and systematic review. Clin J Pain 2002;18:216–233.
 
14. Herrick A, el-Hadidy K, Marsh D, et al. Abnormal thermoregulatory responses in patients with reflex sympathetic dystrophy syndrome. J Rheumatol 1994;21:1319–1324.
 
15. Bej MD, Schwartzman RJ. Abnormalities of cutaneous blood flow regulation in patients with reflex sympathetic dystrophy as measured by laser Doppler fluxmetry. Arch Neurol 1991;48:912–915.
 
16. Clinchot DM, Lorch F. Sympathetic skin response in patients with reflex sympathetic dystrophy.Am J Phys Med Rehabil 1996;75:252–256.
 
17. Kurvers HA, Jacobs MJ, Beuk RJ, et al. Reflex sympathetic dystrophy: evolution of microcirculatory disturbances in time. Pain 1995;60:333–340.
 
18. Kurvers HA, Jacobs MJ, Beuk RJ, et al. Reflex sympathetic dystrophy: result of autonomic denervation? Clin Sci (Lond) 1994;87:663–669.
 
19. Herrick A, el-Hadidy K, Marsh D, Jayson M. Abnormal thermoregulatory responses in patients with reflex sympathetic dystrophy syndrome. J Rheumatol 1994;21:1319–1324.
 
20. Wasner G, Heckmann K, Maier C, et al. Vascular abnormalities in acute reflex sympathetic dystrophy (CRPS I): complete inhibition of sympathetic nerve activity with recovery. [see comment].Arch Neurol 1999;56:613–620.
 
21. Birklein F, Schmelz M, Schifter S, et al. The important role of neuropeptides in complex regional pain syndrome. Neurology 2001;57:2179–2184.
 
22. Bruehl S, Harden RN, Galer BS, et al. Complex regional pain syndrome: are there distinct subtypes and sequential stages of the syndrome? Pain 2002;95:119–124.
 
23. Kim HJ, Na HS, Sung B, et al. Is sympathetic sprouting in the dorsal root ganglia responsible for the production of neuropathic pain in a rat model? Neurosci Lett 1999;269:103–106.
 
24. Zhang JM, Li H, Munir MA. Decreasing sympathetic sprouting in pathologic sensory ganglia: a new mechanism for treating neuropathic pain using lidocaine. Pain 2004;109:143–149.

CME:

Portions of this issue may be available for CME credit. Please email education@sma.org for a complete listing of current Southern Medical Journal activities, as well as other SMA educational offerings.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Member Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

This content is limited to qualifying members. Please click on an option below to view in full. Click here to compare all member plans.

Member Login

Silver/Gold members login for full access. Other members login to view purchase options.

Create a New Account

Create a new complimentary account/login to view purchase options.

Permissions