CRPS: Stellate Ganglion Blockade v. Radiofrequency Neurolysis

CT-guided stellate ganglion blockade vs. radiofrequency neurolysis in the management of refractory type I complex regional pain syndrome of the upper limb

Adrian Kastler, Sébastien Aubry, Nicolas Sailley, Demosthene Michalakis, Gaye Siliman, Guillaume Gory, Jean-Louis Lajoie and Bruno Kastler



EUROPEAN RADIOLOGY
2012, DOI: 10.1007/s00330-012-2704-y

Leonardo da Vinci: Vitruvian Man

Abstract

Objective
To describe and evaluate the feasibility and efficacy of CT-guided radiofrequency neurolysis (RFN) vs. local blockade of the stellate ganglion in the management of chronic refractory type I complex regional pain syndrome (CRPS) of the upper limb.

Methods
Sixty-seven patients were included in this retrospective study between 2000 and 2011. All suffered from chronic upper limb type I CRPS refractory to conventional pain therapies. Thirty-three patients underwent stellate ganglion blockade and 34 benefited from radiofrequency neurolysis of the stellate ganglion. CT guidance was used in both groups. The procedure was considered effective when pain relief was ≥50 %, lasting for at least 2 years.

Results
Thirty-nine women (58.2 %) and 28 men (41.8 %) with a mean age of 49.5 years were included in the study. Univariate analysis performed on the blockade and RFN groups showed a significantly (P < 0.0001) higher success rate in the RFN group (67.6 %, 23/34) compared with the blockade group (21.2 %, 7/33) with an odds ratio of 7.76.

Conclusion  
CT-guided radiofrequency neurolysis of the stellate ganglion is a safe and successful treatment of chronic refractory type I CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade.

Key Points  
• Complex regional pain syndrome is painful, disabling and often refractory to treatment.
• Sixty-seven percent of patients had lasting pain relief (2 years) after radiofrequency neurolysis.
• Retrospective study showed a significantly higher success rate for radiofrequency neurolysis.
• CT guidance is mandatory for a successful and safe procedure.


ABOUT THE AUTHORS

Authors

• Adrian Kastler(136)adriankastler@gmail.com
• Sébastien Aubry(23)
• Nicolas Sailley(2)
• Demosthene Michalakis(2)
• Gaye Siliman(4)
• Guillaume Gory(3)
• Jean-Louis Lajoie(5)
• Bruno Kastler(23)

Author Affiliations

1. Radiology Department, University Hospital CHU Gabriel Montpied, 63000 Clermont-Ferrand, France
2. Radiology and Interventional Pain Unit, University Hospital CHU Jean Minjoz, Besancon, France
3. I4S Laboratory-EA 4268-IFR 133, Franche Comté University, Besancon, France
4. Clinical Investigation Center, University Hospital CHU St Jacques, Besancon, France
5. Pain evaluation and Management Unit, University Hospital CHU Jean Minjoz, Besancon, France
6. Hôpital Gabriel Montpied, CHU Clermont-Ferrand, 58 Rue Montalembert, 63000 Clermont-Ferrand, France

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