Infraclavicular brachial plexus block and infusion for treatment of long-standing complex regional syndrome type 1: a case report.

Complex regional pain syndrome type 1 (CRPS 1) is a perplexing chronic pain condition that frustrates physicians and patients alike. The etiology of the condition resides in multiple theories and diagnosis can be difficult. Therapy focuses on pain management and restoration of physical function. Conservative treatment includes both non-pharmacological and pharmacological methods. Invasive therapy centers on sympathetic and somatic blocks and may evolve to neuromodulatory or neuraxial techniques. In patients with severe pain and extremity contractures with CRPS, often times the invasive blocks help in reduction of resting pain, but are ineffective in alleviating pain related to aggressive physical therapy. Continuous regional blockade with a percutaneous catheter is an effective, but seldom reported technique that can be used to treat both resting and movement related pain. This presentation reviews the results of an infraclavicular brachial plexus infusion used to treat CRPS 1 that developed in a 49 year-old woman following a work-related upper extremity injury. The patient made a dramatic recovery with the infusion, which was maintained for two weeks. A T2-T3 sympathetic radiofrequency thermocoagulation was then performed to maintain pain relief and the infusion was stopped. The patient returned to work and has done well over the ensuing 19 months.