Journal of Clinical Anesthesia
Volume 12, Issue 1 , Pages 67-71, February 2000

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

  • Farrokh R Maneksha, MD (Associate Professor of Clinical Anesthesiology)

      Affiliations

    • Department of Anesthesiology, Health Sciences Center,State University of New York at Stony Brook, Stony Brook, NY, USA
    • Corresponding Author InformationAddress correspondence to Dr. Maneksha at the Department of Anesthesiology, Health Sciences Center, Level 4, State University of New York at Stony Brook, Stony Brook, NY 11794-8480, USA
    • ,
  • Himayun Mirza, MD (Fellow)

      Affiliations

    • Department of Anesthesiology, Health Sciences Center,State University of New York at Stony Brook, Stony Brook, NY, USA
    • ,
  • Paul J Poppers, MD (Distinguished Professor Chairman of Anesthesiology)

      Affiliations

    • Department of Anesthesiology, Health Sciences Center,State University of New York at Stony Brook, Stony Brook, NY, USA

Received 24 June 1999; received in revised form 13 October 1999; accepted 13 October 1999.

Abstract 

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.

Keywords:  Anesthesia, local, complex regional pain syndrome, pediatrics, reflex sympathetic dystrophy

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PII: S0952-8180(99)00126-9

Journal of Clinical Anesthesia
Volume 12, Issue 1 , Pages 67-71, February 2000

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