Article

OBJECTIVE: To identify through case study the presentation and possible
pathophysiological cause of complex regional pain syndrome and its preferential
response to stellate ganglion blockade. SETTING: Complex regional pain syndrome
can occur in an extremity after minor injury, fracture, surgery, peripheral nerve
insult or spontaneously and is characterised by spontaneous pain, changes in skin
temperature and colour, oedema, and motor disturbances. Pathophysiology is likely
to involve peripheral and central components and neurological and inflammatory
elements. There is no consistent approach to treatment with a wide variety of
specialists involved. Diagnosis can be difficult, with over-diagnosis resulting
from undue emphasis placed upon pain disproportionate to an inciting event
despite the absence of other symptoms or under-diagnosed when subtle symptoms are
not recognised. The International Association for the Study of Pain supports the
use of sympathetic blocks to reduce sympathetic nervous system overactivity and
relieve complex regional pain symptoms. Educational reviews promote stellate
ganglion blockade as beneficial. Three blocks were given at 8, 10 and 13months
after the initial injury under local anaesthesia and sterile conditions.
Physiotherapeutic input was delivered under block conditions to maximise joint
and tissue mobility and facilitate restoration of function. CONCLUSION: This case
demonstrates the need for practitioners from all disciplines to be able to
identify the clinical characteristics of complex regional pain syndrome to
instigate immediate treatment and supports the notion that stellate ganglion
blockade is preferable to upper limb intravenous regional anaesthetic block for
refractory index finger pain associated with complex regional pain syndrome.
CI - Copyright (c) 2011 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS