Complex regional pain syndrome (CRPS) with resistance to local anesthetic block: a case report

• Published in: Journal of clinical anesthesia Vol. 12; no. 1; pp. 67 - 71
• Main Authors: Maneksha, Farrokh R, Mirza, Himayun, Poppers, Paul J
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-02-2000; Elsevier Science
• Subjects: Acetates - therapeutic use; Amines; Amitriptyline - therapeutic use; Analgesia, Epidural; Analgesics - therapeutic use; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - therapeutic use; Biological and medical sciences; Bupivacaine - therapeutic use; Child; complex regional pain syndrome; Cyclohexanecarboxylic Acids; Drug Resistance; Female; gamma-Aminobutyric Acid; Humans; Hydrocodone - therapeutic use; Lidocaine - therapeutic use; local; Local anesthesia. Pain (treatment); Medical sciences; Nerve Block - methods; pediatrics; Physical Therapy Modalities; Posterior Horn Cells - drug effects; Receptors, N-Methyl-D-Aspartate - drug effects; Receptors, N-Methyl-D-Aspartate - physiology; reflex sympathetic dystrophy; Reflex Sympathetic Dystrophy - physiopathology; Reflex Sympathetic Dystrophy - therapy; Sympathetic Nervous System - drug effects; reflex sympathetic dystrophy; Anesthesia; complex regional pain syndrome; local; pediatrics; Human; Nervous system diseases; Reflex sympathetic dystrophy; Local anesthetic; Case study; Analgesia; Regional anesthesia; Pain; Treatment; Extradural administration; Diseases of the autonomic nervous system; Child; Negative therapeutic reaction
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(99)00126-9

We present a case of complex regional pain syndrome (CRPS) Type 1 in a 12-year-old girl. The patient did not respond to the usual therapeutic modalities used to treat CRPS, including physical therapy, lumbar sympathetic block, epidural local anesthetic block, intravenous lidocaine infusion, or other oral medications. Of note is the fact that, during epidural block, the patient demonstrated a resistance to local anesthetic neural blockade in the area of the body involved with the pain problem. The mechanism of this resistance could be related to the changes in the dorsal horn cells of the spinal cord, secondary to activation of N-methyl-D-aspartate receptors, which may play a role in the pathophysiology of this pain syndrome.