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Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
LAURETTI, Gabriela Rocha; VELOSO, Fabrício dos Santos and MATTOS, Anita Leocádia de. Functional rehabilitation and analgesia with botulinum toxin A in upper limb complex regional pain syndrome type I: case reports. Rev. Bras. Anestesiol. [online]. 2005, vol.55, n.2, pp. 207-211. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942005000200007.
BACKGROUND AND OBJECTIVES: Functional inability of the affected limb is often added to alodynia and hyperalgesia in Complex Regional Pain Syndrome (CRPS) type I. Two CRPS cases are reported in which botulinum toxin A as coadjuvant drug has contributed to motor and functional recovery of the affected limb. CASE REPORTS: Two CRPS type I patients were initially evaluated for upper limb pain control. Both were unable to open the hand and referred pain intensity by numeric analog scale (NAS) of 10 at rest or when hand and fingers were passively manipulated. A sequence of 5 weekly ipsilateral stellate ganglion blockade with clonidine and lidocaine was started. Simultaneously, during the third stellate ganglion blockade, 75 Ul botulinum toxin A was administered to flexor muscles of phalanges and wrist joint. One week after botulin toxin A administration patients presented phalanges and wrist relaxation, reported easy passive physical therapy and pain was classified as 2 (NAS) at passive manipulation. At stellate ganglion blockade sequence completion patients were submitted to 3 weekly regional intravenous clonidine, lidocaine and parecoxib. At 8 months evaluation patients presented 70% and 80% motor and functional recovery of the affected limb. CONCLUSIONS: Muscular botulin toxin A has resulted in movement improvement of the affected limb and analgesia, favoring functional recovery.
Keywords : DRUGS [botulinum toxin A]; PAIN, Chronic [complex regional pain syndrome type I].