Simpatectomía a cielo abierto como opción de tratamiento del Síndrome del dolor regional complejo tipo I: relato de caso y revisión

Introduction: Reflex sympathetic dystrophy (RSD) is also known as algoneurodystrophy, causalgia, fibromyalgia, Sudeck’s atrophy or complex regional pain syndrome type I (CRPS-I). Case report: A 22-years-old female patient with a report of fall from great height with trauma in the extension of the right upper limb. It evolved after the event with pain and diffuse paresthesias in the right upper limb. Electroneuromyography of the upper limbs showed no relevant alterations. In spite of the use of diverse medicines, she continued with intractable pain, which impedes the accomplishment of physiotherapy properly. The sympathectomy of the lower cervical ganglion was chosen. In the postoperative period, she evolved with ipsilateral Horner syndrome, as we expected, with moderate pain control. Discussion: In the CRPS-I we note that mild to moderate limb injuries or distant areas of the dystrophy zone may precede the onset of symptoms. There is no lesion of a specific nerve in electrophysiological studies and the clinical picture is characterized by a range of sensory motor and dysautonomic symptoms. As for drugs, there is no unanimity, and it is still possible to use star-shaped ganglion block and sympathectomy. Conclusion: Cervico-thoracic ganglion (stellate ganglion) sympathectomy may be an option for the treatment of CRPS-I when conservative treatment modalities do not promote a satisfactory outcome.