Official websites use. Share sensitive information only on official, secure websites. This review is an update of a previously published review in the Cochrane Database of Systematic Reviews, , Issue 4 and last updated in the Cochrane Database of Systematic Reviews, issue 8 , on local anaesthetic blockade LASB of the sympathetic chain to treat people with complex regional pain syndrome CRPS.
To assess the efficacy of LASB for the treatment of pain in CRPS and to evaluate the incidence of adverse effects of the procedure. For this update we searched the Cochrane Central Register of Controlled Trials CENTRAL , Issue 9 , MEDLINE Ovid , EMBASE Ovid , LILACS Birme , conference abstracts of the World Congresses of the International Association for the Study of Pain, and various clinical trial registers up to September We also searched bibliographies from retrieved articles for additional studies.
We considered randomised controlled trials RCTs that evaluated the effect of sympathetic blockade with local anaesthetics in children or adults with CRPS compared to placebo, no treatment, or alternative treatments. We used standard methodological procedures expected by Cochrane. The outcomes of interest were reduction in pain intensity, the proportion who achieved moderate or substantial pain relief, the duration of pain relief, and the presence of adverse effects in each treatment arm.
We assessed the evidence using GRADE Grading of Recommendations Assessment, Development and Evaluation and created a 'Summary of findings' table. For this update, we excluded studies that did not follow up patients for more than 48 hours. As a result, we excluded four studies from the previous review in this update. Overall, the quality of evidence was low to very low, downgraded due to limitations, inconsistency, imprecision, indirectness, or a combination of these.
Of two studies that investigated LASB as an addition to rehabilitation treatment, the only study that reported pain outcomes demonstrated no additional benefit from LASB very low quality evidence. Eight small randomised studies compared sympathetic blockade to various other active interventions. Most studies found no difference in pain outcomes between sympathetic block versus other active treatments low to very low quality evidence. This update's results are similar to the previous versions of this systematic review, and the main conclusions are unchanged.
