Introduction: Complex regional pain syndrome (CRPS) is a serious complication of injuries and is accompanied by severe pain and dystrophy due to sympathetic downregulation with a subsequent failure of microcirculation. Any peripheral sympathetic blockades for pain relieve and improving local perfusion make the treatment more effective. At our department we use a novocain vagosympathetic “coat-blockade” according to Soviet surgeon A.V.Vishnevsky, too.
Method: This method stands for infiltrating the patient’s limb with a large volume of diluted solution of 0.25% novocaine in a balanced ion solution (the Vishnevsky solution). Patient’s limb is injected with 40 to 80 mL proximally from the site of lesion. This therapy is given to outpatients. 
Results: In our non-homogenic cohort of 30 patients (11 males and 19 females; age of 14 to 78 years, average 51.7 years) we had 22 patients with a CRPS Type 1 (Algodystrophy, Reflex Sympathetic Dystrophy) and 8 patients with a CRPS Type 2 (Causalgia). Upper limbs are affected in 18 patients, lower limbs in 12 patients. We use 40 ml of novocaine solution for an arm, forearm or calf distribution, and 80 ml for a thigh within one session as a supplement to a standard pain therapy (antidepressants, gabapentinoids, opioids). These administrations are performed usually in a series of 10 at one-week intervals. Average NRS prior to therapy was 7.8 points and after therapy 4.1 points. Using this therapy, we achieved an average pain relief of 3.7 points on NRS for several weeks or months or an improvement of movement in the affected limb. We registered only slight local sensitivity in site of injection as a side effect.
Conclusion: The vagosympathetic coat-blockade according to Vishnevsky can be a useful supplement to a very difficult therapy of a complex regional pain syndrome before we opt for more invasive techniques, such as sympathetic blockades.

PERIPHERAL VAGOSYMPATHETIC BLOCKADE IN THE CRPS THERAPY