title: Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: the use of intravenous regional anesthesia with clonidine.
abstract: OBJECTIVE
  To evaluate the efficacy of intravenous regional anesthesia (IVRA) with clonidine in patients with a previous history of complex regional pain syndrome (CRPS) who are undergoing upper extremity hand surgery.
  
  
  METHODS
  Prospective, randomized, double-blind study.
  
  
  METHODS
  Operating suites and Pain Management Center of a large university-affiliated medical center.
  
  
  METHODS
  84 patients with a previous history of upper extremity CRPS undergoing surgery on the affected extremity. All signs and symptoms of CRPS had resolved prior to the time of surgery.
  
  
  METHODS
  Patients were randomized to receive IVRA with 0.5 % lidocaine with either 1 mL normal saline (n=42) or clonidine 1 microg/kg (n=42) added to the lidocaine solution.
  
  
  METHODS
  Recurrence of CRPS symptoms at 1 year following surgery were recorded.
  
  
  RESULTS
  The recurrence rate of CRPS was significantly lower (p <0.001) in those patients receiving IVRA with lidocaine and clonidine (10%, n=4) compared with those patients receiving IVRA lidocaine only (74%, n=31).
  
  
  CONCLUSIONS
  Intraoperative IVRA with lidocaine and clonidine on patients with a history of CRPS can significantly reduce the recurrence rate of this disease process.
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA. scott.reuben@bhs.org
authors.forename: Scott S
authors.initials: SS
authors.lastname: Reuben
authors.forename: Erik A
authors.initials: EA
authors.lastname: Rosenthal
authors.forename: Robert B
authors.initials: RB
authors.lastname: Steinberg
authors.forename: Shameema
authors.initials: S
authors.lastname: Faruqi
authors.forename: Prasad A
authors.initials: PA
authors.lastname: Kilaru
mesh_terms: D000765:Anesthesia, Conduction / Q000379:methods*; D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D003000:Clonidine; D020918:Complex Regional Pain Syndromes / Q000517:prevention & control / Q000601:surgery*; D004311:Double-Blind Method; D005260:Female; D006225:Hand; D006801:Humans; D007275:Injections, Intravenous; D008012:Lidocaine; D008297:Male; D011446:Prospective Studies; D055502:Secondary Prevention
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D008012:Lidocaine; D003000:Clonidine