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This investigational combination therapy consists of **botulinum toxin type A (BTA)** and the local anesthetic **ropivacaine**, specifically evaluated by **Seoul National University** for the treatment of upper extremity **Complex Regional Pain Syndrome (CRPS)**. Botulinum toxin type A is a neurotoxic protein that inhibits the release of acetylcholine from cholinergic nerve endings by cleaving the synaptosomal-associated protein 25 (SNAP-25). In the context of CRPS, it is administered via a thoracic sympathetic ganglion block. The rationale is that pre-ganglionic sympathetic nerves are cholinergic; therefore, BTA can prolong the duration of the sympathetic blockade compared to traditional local anesthetics alone. Ropivacaine provides the initial anesthetic effect, while BTA offers a long-lasting, non-permanent reduction in sympathetically maintained pain without the cytotoxicity or permanent injury risks associated with chemical neurolysis or radiofrequency thermocoagulation.
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