Intravenous reserpine for treatment of reflex sympathetic dystrophy

The efficacy of reserpine in relieving the pain of reflex sympathetic dystrophy was tested in 25 patients--21 with upper extremity and four with lower extremity involvement. Injection of the drug relieved the acute signs and symptoms in the upper extremity in 12 of 17 patients. Four patients with quiescent reflex sympathetic dystrophy of upper extremities had prophylactic injection at the time of reconstructive surgery; they had no flare of symptoms. Relief was obtained in the four cases of lower extremity dystrophy. Our patients had no significant side effects. The drug is confined to the extremity by a pneumatic tourniquet as used for intravenous regional anesthesia. After the extremity is exsanguinated and the cuff is inflated, 1 mg of reserpine diluted to 50 ml with normal saline is injected intravenously into the upper extremity. In the lower extremity, 2 mg of reserpine diluted to 100 ml is injected. The tourniquet is removed after 15 minutes. The procedure is safe and can be done in an office setting.