Candan Burcu, Gungor Semih
Division of Musculoskeletal and Interventional Pain Management, Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY 10021, USA.
Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10065, USA.
J Clin Med. 2025 Mar 18;14(6):2060. doi: 10.3390/jcm14062060.
: The pathophysiological mechanisms of temperature asymmetry differ between patients with warm and cold subtypes of Complex Regional Pain Syndrome (CRPS). Consequently, the response to lumbar sympathetic blocks (LSBs) and the resulting temperature improvement may vary between these two subtypes. We aimed to evaluate whether there was a significant difference in temperature elevation following sympathetic blocks in warm versus cold subtypes of CRPS. : We calculated the temperature difference by analyzing forward-looking infrared (FLIR) thermal camera images of the affected extremity at pre-block and 5-min post-block time points. The primary outcome measure was that the mean temperature increase following LSB would be higher in the cold CRPS group than in the warm CRPS group. The secondary outcome measure was that the mean temperature elevation following the sympathetic block in the cold CRPS subtype would be at least 50% higher than in the warm CRPS subtype. : The study assessed warm and cold CRPS subtypes by analyzing temperature profiles from 90 lumbar sympathetic blocks performed on 34 patients. The temperature change in the affected extremity following LSB varied widely, with the highest increase observed in one patient at 10.99 °C. The cold CRPS patients demonstrated a higher mean temperature increase at the 5 min time point following LSB, averaging 3.37 °C in initial cases and 2.67 °C across all cases. In comparison, warm CRPS patients had lower mean increases of 0.58 °C in initial cases and 1.23 °C across all cases. Notably, the mean temperature rise in the cold CRPS group exceeded that of the warm CRPS group by more than 50%, meeting the secondary outcome goal. : Our results indicated that patients with the cold subtype of CRPS tend to experience greater temperature improvements compared to those with the warm subtype after undergoing a sympathetic block. Therefore, our findings suggest that the criteria for determining the success of a sympathetic block should be revised to account for the cold and warm subtypes of CRPS.
复杂性区域疼痛综合征（CRPS）的温热型和寒冷型患者体温不对称的病理生理机制有所不同。因此，这两种亚型对腰交感神经阻滞（LSB）的反应以及由此导致的体温改善情况可能存在差异。我们旨在评估CRPS温热型与寒冷型患者在交感神经阻滞后体温升高是否存在显著差异。
我们通过分析阻滞前和阻滞后5分钟时患侧肢体的前瞻性红外（FLIR）热成像相机图像来计算温度差。主要结局指标是，寒冷型CRPS组腰交感神经阻滞后的平均体温升高幅度高于温热型CRPS组。次要结局指标是，寒冷型CRPS亚型交感神经阻滞后的平均体温升高幅度比温热型CRPS亚型至少高50%。
该研究通过分析对34例患者进行的90次腰交感神经阻滞的温度曲线来评估CRPS的温热型和寒冷型。腰交感神经阻滞后患侧肢体的温度变化差异很大，一名患者的最高升温幅度为10.99℃。寒冷型CRPS患者在腰交感神经阻滞后5分钟时的平均体温升高幅度更高，初始病例平均为3.37℃，所有病例平均为2.67℃。相比之下，温热型CRPS患者初始病例的平均升温幅度较低，为0.58℃，所有病例平均为1.23℃。值得注意的是，寒冷型CRPS组的平均体温升高幅度超过温热型CRPS组50%以上，达到了次要结局目标。
我们的结果表明，与温热型CRPS患者相比，寒冷型CRPS患者在接受交感神经阻滞后体温改善更为明显。因此，我们的研究结果表明，应修订交感神经阻滞成功的判定标准，以考虑CRPS的寒冷型和温热型。
