CRRF Kerpape, 56275 Ploemeur cedex, France.
Ann Phys Rehabil Med. 2010 Aug-Sep;53(6-7):406-16. doi: 10.1016/j.rehab.2010.06.002. Epub 2010 Jul 2.
To evaluate the use of continuous interscalene brachial plexus block with bupivacaine to treat complex regional pain syndrome (CRPS) type 1 of the shoulder in adult patients who were refractory to standard therapies.
We performed a prospective, cross-sectional study of 59 cases of treatment-refractory CRPS type 1 of the shoulder. The patients were treated with one week of continuous interscalene brachial plexus block with bupivacaine and concomitant rehabilitation in a specialist centre. After withdrawal of the catheter, rehabilitation was continued for a further 3 weeks. The outcomes at 1, 6 and 12 months were evaluated in terms of the Constant score, the verbal numeric rating scale (VNRS) for pain, joint range of motion and medication use. Patients were later interviewed by telephone and asked to state their professional situation, the current VNRS score for pain and the status of their CRPS.
In the first month of treatment, the mean VNRS pain score fell from 7.4 to 3.6, the Constant score rose from 21.7 to 56.6% and the joint range of motion increased from 5.4 to 29.9° for external rotation (ER) position 1 and from 38.6 to 74.2° for abduction. These improvements persisted over time, despite a very slight reduction at 6 months. 86% of the interviewed patients reported that the treatment protocol had improved or greatly improvement their condition. 46% of the respondees had been able to return to work.
Treatment with a combination of a 1-week continuous interscalene brachial plexus block and rehabilitation may be a good option for patients with CRPS type 1 of the shoulder and who are refractory to standard therapies.
评估布比卡因连续肌间沟臂丛阻滞治疗对标准治疗无效的成人肩部复杂性区域疼痛综合征（CRPS）1 型的效果。
我们对 59 例肩部难治性 CRPS 1 型患者进行了前瞻性、横断面研究。患者在专科中心接受为期一周的布比卡因连续肌间沟臂丛阻滞治疗和同时进行康复治疗。拔出导管后，再继续康复治疗 3 周。在 1、6 和 12 个月时，采用 Constant 评分、疼痛数字评分量表（VNRS）、关节活动度和药物使用情况评估结局。之后通过电话对患者进行随访，询问他们的职业状况、当前疼痛 VNRS 评分以及 CRPS 状况。
治疗的第一个月，平均 VNRS 疼痛评分从 7.4 分降至 3.6 分，Constant 评分从 21.7%升至 56.6%，外旋（ER）位 1 的关节活动度从 5.4°增加到 29.9°，外展位从 38.6°增加到 74.2°。尽管在 6 个月时略有下降，但这些改善持续存在。86%的接受访谈的患者报告说，治疗方案改善或极大地改善了他们的病情。46%的应答者能够重返工作岗位。
连续肌间沟臂丛阻滞联合康复治疗可能是标准治疗无效的肩部 CRPS 1 型患者的一种较好选择。
