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Axillary brachial plexus blockade for the reflex sympathetic dystrophy syndrome
G M Ribbers1, A C Geurts, R A Rijken
1Rehabilitation Centre Rijndam, Rotterdam, The Netherlands.
Summary
Brachial plexus blockade (BPB) may effectively treat reflex sympathetic dystrophy syndrome (RSD) by targeting C- and A delta-fibres. Early-stage RSD patients showed positive responses to BPB, suggesting its potential as a treatment modality.
Area of Science:
- Pain Management
- Neurology
- Anesthesiology
Background:
- Reflex sympathetic dystrophy syndrome (RSD) is a neurogenic pain disorder with unknown pathogenesis.
- Historically, the sympathetic nervous system was implicated, leading to sympathectomies.
- Emerging evidence highlights the role of C- and A delta-fibres in RSD etiology.
Observation:
- Six patients with severe upper extremity RSD were treated with brachial plexus blockade (BPB).
- BPB targets both sympathetic efferents and somatosensory C- and A delta-afferents.
- Patients were treated in an outpatient rehabilitation setting with 12-21 months follow-up.
Findings:
- Three patients responded well to BPB, with treatment intervals of 3-6 months (RSD stages 1 and 2).
- Three patients showed poor response; one discontinued due to infection, others had longer treatment intervals (7-25 months) and stage 3 RSD.
- BPB demonstrated potential in early stages of RSD.
Implications:
- BPB is a regional anesthetic technique that warrants further investigation for RSD treatment.
- The findings support evaluating BPB's efficacy, particularly in early-stage reflex sympathetic dystrophy syndrome.
- Further research is needed to confirm BPB as a viable treatment option for RSD.