title: Complex regional pain syndrome (CRPS) with resistance to local anesthetic block: a case report.
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.
authors.affiliation: Department of Anesthesiology, Health Sciences Center, State University of New York at Stony Brook, NY 11794-8480, USA.
authors.forename: F R
authors.initials: FR
authors.lastname: Maneksha
authors.forename: H
authors.initials: H
authors.lastname: Mirza
authors.forename: P J
authors.initials: PJ
authors.lastname: Poppers
mesh_terms: D000085:Acetates / Q000627:therapeutic use; D000588:Amines; D000639:Amitriptyline / Q000627:therapeutic use; D015360:Analgesia, Epidural; D000700:Analgesics / Q000627:therapeutic use; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D002648:Child; D003509:Cyclohexanecarboxylic Acids; D004351:Drug Resistance; D005260:Female; D000077206:Gabapentin; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D008012:Lidocaine / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods*; D026741:Physical Therapy Modalities; D020671:Posterior Horn Cells / Q000187:drug effects; D016194:Receptors, N-Methyl-D-Aspartate / Q000187:drug effects / Q000502:physiology; D012019:Reflex Sympathetic Dystrophy / Q000503:physiopathology / Q000628:therapy*; D013564:Sympathetic Nervous System / Q000187:drug effects; D005680:gamma-Aminobutyric Acid
chemical_list: D000085:Acetates; D000588:Amines; D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D003509:Cyclohexanecarboxylic Acids; D016194:Receptors, N-Methyl-D-Aspartate; D000639:Amitriptyline; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D006853:Hydrocodone; D008012:Lidocaine; D002045:Bupivacaine