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Sympathectomy for complex regional pain syndrome
Bhugwan Singh1, Jaynathan Moodley, Ahmed S Shaik
1Department of Surgery, Nelson R. Mandela School of Medicine, Faculty of Health Sciences, University of Natal, 4013 Congella, South Africa.
Journal of Vascular Surgery
|March 6, 2003
Summary
Early sympathectomy for complex regional pain syndrome (CRPS) offers significant improvement. Prompt surgical intervention in CRPS type II of the upper extremity yields better outcomes, especially when performed early.
Area of Science:
- Pain Management
- Surgical Interventions
- Neurology
Background:
- Complex Regional Pain Syndrome (CRPS) recognition is improving.
- Therapeutic strategies, including sympathectomy timing, require re-evaluation.
- CRPS type II of the upper extremity was studied.
Purpose of the Study:
- To assess the efficacy of sympathectomy in CRPS type II.
- To determine the optimal timing for sympathectomy.
- To compare thoracoscopic versus open sympathectomy outcomes.
Main Methods:
- 42 patients with CRPS type II underwent sympathectomy over 9 years.
- Patients were grouped by symptom duration: <3 months (Group I) and >3 months (Group II).
- Thoracoscopic sympathectomy was attempted, with open sympathectomy as an alternative; outcomes were assessed using a visual analogue scale.
Main Results:
- All 42 patients showed improvement post-sympathectomy (P <.001).
- Early intervention (Group I) yielded significantly better outcomes than later intervention (Group II) (P <.003).
- Thoracoscopic sympathectomy resulted in better outcomes, shorter hospital stays, and no complications compared to open procedures.
Conclusions:
- Early recognition and prompt surgical sympathectomy are beneficial for managing CRPS.
- Thoracoscopic dorsal sympathectomy is a safe and effective treatment option for CRPS type II.
- Timely sympathectomy is crucial for optimizing patient outcomes in CRPS management.