Low-volume ulnar nerve block within the axillary sheath for the treatment of reflex sympathetic dystrophy.

A case is described of reflex sympathetic dystrophy (RSD) of the upper limb following cerebral arteriography via the subclavian artery. The pain started in the hand and forearm but, over several weeks, spread to involve the whole arm. After identifying the ulnar nerve in the axillary bundle with a stimulator, a series of small volume injections (bupivacaine 0.5% with epinephrine 2.5 ml and methyl-prednisolone 40 mg) was given. These relieved the pain and reversed the trophic changes of RSD. It is suggested that this approach is a useful alternative treatment in cases of RSD of the upper extremity.