Collins Regional Anesthesia Pdf |WORK|
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A prospective crossover study with 20 patients found a positive effect of dimethylsulphoxide (DMSO) on the function of the affected limb. In 26 CRPS-I patients DMSO was found to be significantly more effective than the conventional regional ismelin block [23] in reducing pain. A randomised double-blind trial conducted with 32 CRPS-I patients [24] showed that 5 times daily use of DMSO in cremor vaselini cetomacrogolis provided significantly better results on CRPS-I symptoms than placebo after two months of treatment. A randomized double-blind study in 146 CRPS-I patients found comparable results for DMSO cream and N-acetylcysteine [9]. In general, DMSO generates lower (direct and indirect) costs than N-acetylcysteine. Subgroup analysis indicates that N-acetylcysteine is more cost effective in patients with a cold form of CRPS-I than DMSO. The opposite holds for warm forms of CRPS-I [25].
Neurolysis of the trigger point [17] and regional sympathetic blockades [26] have been described to be effective in the treatment of CRPS-I. The results of these methods are comparable to the effects of neurolytic blockades. Both neurolysis and sympathetic blockades are effective in the treatment of CRPS-I of the head and neck, but not in CRPS-I of the extremities [29].
In a study of patients with CRPS-I in an orofacial region, 50% of the patients in the analgesic group and 40% in the placebo group relapsed. There was a tendency towards a more rapid relapse in the placebo group, although this difference was not statistically significant (p = 0.09) [12].
Supraorbital and occipital nerve blockades were found to be effective in a case report [107]. Focusing on CRPS-I after stroke, intravenous regional lidocaine was tested in eight patients [108].
In a trial, intravenous lidocaine in combination with valproate was investigated for the treatment of complex regional pain syndrome [104]. The effect of lidocaine with valproate was superior to lidocaine alone. A significant reduction of pain was demonstrated in patients with CRPS-I over a period of 6 months.
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