• G Gradl, A Beyer, S Azad, and M Schürmann.
• Chirurgische Klinik und Poliklinik, Abteilung für Unfall- und Wiederherstellungschirurgie der Universität Rostock. georg.gradl@med.uni-rostock.de
• Anasthesiol Intensivmed Notfallmed Schmerzther. 2005 Jun 1;40(6):345-9.

ObjectiveThe aim of this study was to evaluate continuous brachial plexus analgesia in terms of pain relief and sympathicolysis in patients suffering from CRPS I.MethodsA detailed clinical examination comprised measurement of temperature changes (Infrared Thermometry), pain rating (VAS scale) and assessment of peripheral sympathetic nervous function using laser Doppler flowmetry. A total number of 12 patients (mean age: 56 +/- 9 years, range: 30 to 69 years) received continuous brachial plexus analgesia after placing a catheter in the perineurial sheath of the brachial plexus through an axillary approach. Prior to continuous analgesia (Morphin 0.04 mg/ml, Clonidin 1.5 microg/ml, Bupivacaine 0.0625 %) running at 4 ml/h a test dosis of 20 ml Bupivacaine 0.25 % was applied to establish brachial plexus block.ResultsAfter an equilibration period of 2 hours, consecutive pain measurements revealed sufficient pain relief in 9 out of 12 patients (75 %) with a mean pain rating dropping from 4.7 +/- 0.68 to 1.59 +/- 1.02 (p < 0.001). Pain reduction was accompanied by a significant temperature increase from -0.78 degrees C to 1.7 degrees C (p < 0.05). However measurement of sympathetic function by laser Doppler flowmetry revealed that no significant sympathicolysis occurred.ConclusionsThe study shows that clinical investigation of temperature change is not reliable in the evaluation of sympathicolysis. This is of special interest in patients who are suspected of having sympathically maintained pain (SMP) and are treated by brachial plexus analgesia.

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