Presented at the 2012 AAPM Annual Meeting « Back

Stellate Ganglion Blockade Versus Radiofrequency Neurolysis in the Management of Refractory Complex Regional Pain Syndrome of the Upper Limb: A Comparison Study Based On 61 Procedures

Adrian Kastler, MD, tomasi@noos.fr¹, Sébastien Aubry, MD PhD², Nicolas Sailley, MD², Véronique Piccand, MD³, Florence Tiberghien, MD⁴, Bruno Kastler, MD PhD², (1) Radiology, Clermont Ferrand, Auvergne, France, (2) Interventional Pain Managment Unit, Besancon, Doubs, France, (3) Medecine, Besancon, Doubs, France, (4) CETD CHu jean Minjoz, Besancon, Doubs, France

Purpose: To retrospectively compare stellate ganglion block and radiofrequency in the management of complex regional pain syndrome (CRPS) of the upper limb. Method and Materials: Sixty-one patients were included in this retrospective study between 2000 and 2010. All patients suffered from chronic refractory upper limb CRPS. Twenty-nine patients underwent stellate ganglion blockade and 32 underwent Radiofrequency Neurolysis of the stellate ganglion. CT guidance was the rule in both groups. The procedure was considered to be effective when pain relief was equal to or greater than 50% lasting for at least 2 years. Mean duration of pain prior to procedure as well as mean duration of pain relief in case of failure were noted. Results: Thirty-five women (57.3%) and 26 men (42.7%) with a mean age of 48.4 years were included in the study. Statistical analysis showed significant results in favor of Radiofrequency Neurolysis with an odds ratio of 7.32 (Fisher exact test). A total of 21/32 RF procedures (65.6%) were a success, compared to 6/29 successful procedures (20.6%) in the stellate ganglion blockade group (p = 0.001). Moreover, the mean duration of pain prior to procedure appeared to be significantly higher (30 months) in case of failure (P = 0.05). Conclusion: Radiofrequency Neurolysis of the stellate ganglion block is a safe and successful treatment of chronic refractory CRPS of the upper limb. It appears to be more effective than stellate ganglion blockade, especially when performed with a reasonable delay after onset of symptoms.

Funding: None