Local anaesthetic sympathetic blockade for complex regional pain syndrome
Information
- DOI:
- https://doi.org/10.1002/14651858.CD004598.pub4Copy DOI
- Database:
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- Cochrane Database of Systematic Reviews
- Version published:
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- 28 July 2016see what's new
- Type:
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- Intervention
- Stage:
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- Review
- Cochrane Editorial Group:
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Cochrane Pain, Palliative and Supportive Care Group
- Copyright:
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- Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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Authors
Contributions of authors
NEO: informed the modification of the protocol; acted as the arbiter reviewer; led the data synthesis and the writing of the manuscript.
BMW: informed the modification of the protocol; screened, identified and evaluated studies; extracted data; and contributed to the writing of the manuscript.
WG: informed the modification of the protocol; screened, identified and evaluated studies; extracted data; and contributed to the writing of the manuscript
DBC: designed the original protocol and consulted on the modifications; contributed to the writing of the manuscript.
FB: informed the modification of the protocol; assisted in the clinical trial register searches; and contributed to the writing of the manuscript.
TRS: led the modification and writing of the protocol; performed the literature search; screened, identified and evaluated studies; extracted data; informed the data synthesis; and informed the writing of the manuscript.
Sources of support
Internal sources
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No sources of support supplied
External sources
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Saltonstall Foundation, USA
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Javeriana University School of Medicine, Colombia
Declarations of interest
NEO: none known.
BMW: none known.
WG: none known.
DBC: none known; DBC practiced anesthesiology and pain medicine in busy academic medical centers from 1986‐2005, directly treating patients with CRPS, but has not treated people with CRPS since 2005.
FB: none known; FB is a practicing neurologist and pain treatment specialist who treats patients with CRPS.
TRS: none known.
Acknowledgements
We thank the Pain, Palliative and Supportive Care Review Group for running the searches and supporting the review process.
We would also like to thank Arturo Lawson, Murat Dalkilinc, Luciana Macedo, Ann Meulders, Eric Parent, Andrea Wand, Eva Bosch and Ein‐Soon Shin for their assistance in interpreting non‐English language trials.
Cochrane Review Group funding acknowledgement: The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane PaPaS Group. Disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, National Health Service (NHS) or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2016 Jul 28 | Local anaesthetic sympathetic blockade for complex regional pain syndrome | Review | Neil E O'Connell, Benedict M Wand, William Gibson, Daniel B Carr, Frank Birklein, Tasha R Stanton | |
| 2013 Aug 19 | Local anaesthetic sympathetic blockade for complex regional pain syndrome | Review | Tasha R Stanton, Benedict M Wand, Daniel B Carr, Frank Birklein, Gunnar L Wasner, Neil E O'Connell | |
| 2005 Oct 19 | Local anaesthetic sympathetic blockade for complex regional pain syndrome | Review | M Soledad Cepeda, Daniel B Carr, Joseph Lau | |
| 2004 Jan 26 | Local anesthetic sympathetic blockade for complex regional pain syndrome | Protocol | Soledad Cepeda, Daniel B. Carr | |
Differences between protocol and review
This 2016 updated review used an expanded search strategy. In particular, we used additional search terms and also searched clinical trial registers for potentially relevant studies. For this update, we excluded studies that had only immediate follow‐up data (≤ 48 h), because this information provides little clinically relevant information about the clinical effectiveness of this treatment.
Further, we used an updated version of the 'Risk of bias' assessment – specifically, we included 'size of treatment groups' and 'duration of follow‐up' in the 'Risk of bias' evaluation. This updated review also included studies comparing local anaesthetic blockade (LASB) versus other active treatments (original review compared LASB with placebo/inert treatments only). Lastly, we updated the data analysis that included consideration of the minimally important difference (as per OMERACT 12 group recommendations) and evaluation of the level of evidence using the GRADE approach.
Notes
Assessed for updating in 2016
A new search within two years is not likely to identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be re‐assessed for updating in five years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.
Assessed for updating in 2021
In March 2021 we did not identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be reassessed for updating in two years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.
Please note that Neil O'Connell is the PaPaS Co‐ordinating Editor and he was not involved in the editorial assessment or decisions when considering this review for updating; we thank the Editors Dr Peter Cole and Professor Christopher Eccleston for their input.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Adult; Child; Humans;
PICOs
#Study flow diagram for updated searches
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
| Patient or population: adults with CRPS Setting: secondary care Intervention/comparison: LASB vs various comparisons Outcome: pain intensity 0‐10 (VAS or NRS) | ||||
| Comparison | Studies | No of participants | Result (effect estimates reported where available from study report) | Quality of the evidence |
|---|---|---|---|---|
| LASB vs placebo | 23 (2) | No significant between‐group difference | ⊕⊕⊕⊝ Moderatea | |
| Thoracic LASB + steroid vs subcutaneous local anaesthetic+ steroid | 36 (1) | Favours LASB Mean difference (0‐10 scale) One month −1.25 (95% CI −3.2 to 0.7) One year −2.39 (95% CI −4.72 to −0.06) | ⊕⊝⊝⊝ Very lowb | |
| LASB vs ultrasound block | 18 (1) | No significant between‐group difference | ⊕⊕⊝⊝ Lowc | |
| LASB vs IVRB guanethidine | 19 (1) | No significant between‐group difference | ⊕⊝⊝⊝ Very lowb | |
| LASB lumbar plexus vs pulsed radiofrequency lumbar plexus | 40 (1) | No significant between‐group difference | ⊕⊝⊝⊝ Very lowb | |
| LASB (lidocaine + clonidine) vs IVRB (lidocaine + clonidine) | 43 (1) | No significant between‐group difference | ⊕⊝⊝⊝ Very lowb | |
| LASB + PT+ pharmacological vs PT + pharmacological | 82 (1) | Favours SGB group | ⊕⊝⊝⊝ Very lowb | |
| LASB + PT vs PT | 60 (1) | No significant between‐group difference | ⊕⊝⊝⊝ Very lowb | |
| Continuous LASB vs continuous brachial plexus block | 33 (1) | Favours brachial plexus block | ⊕⊕⊝⊝ Lowc | |
| Image‐guided LASB vs nonimage‐guided LASB | 42 (1) | Mean difference 2 weeks postinjection −0.58 (95% CI −1.51 to 0.35) 4 weeks postinjection −0.74 (95% CI −1.36 to −0.12) | ⊝⊝⊝⊝ Very lowd | |
| Outcome: hand pain 0‐3 scale | ||||
| LASB vs oral corticosteroids | 38 (1) | 15 day follow‐up, no significant between‐group difference at 30 day follow‐up 0.4 (95% CI −0.69 to −0.11), favours LASB with steroid | ⊝⊝⊝⊝ Very lowd | |
| Outcome: duration of pain relief | ||||
| LASB bupivacaine + BTA vs LASB bupivacaine | 9 (1) | Increased duration of relief with BTA Median time to analgesic failure (days): LASB bupivacaine + BTA 71 (95% CI 12 to 253) LASB bupivacaine 10 (95%CI 0 to 12) | ⊕⊕⊝⊝ Lowc | |
| a Downgraded once for imprecision. | ||||
| To make the clinical diagnosis, the following criteria must be met:
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| 1. Continuing pain, which is disproportionate to any inciting event
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| 2. Must report at least one symptom in three of the four following categories.
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| 3. Must display at least one sign at time of evaluation in two or more of the following categories:
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| 4. There is no other diagnosis that better explains the signs and symptoms
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| For research purposes, diagnostic decision rule should be at least one symptom in all four symptom categories and at least one sign (observed at evaluation) in two or more sign categories. A sign is counted only if it is observed at time of diagnosis. |
