Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: the use of intravenous regional anesthesia with clonidine.
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.
Reuben
Scott S
SS
Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA. scott.reuben@bhs.org
Rosenthal
Erik A
EA
Steinberg
Robert B
RB
Faruqi
Shameema
S
Kilaru
Prasad A
PA
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
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D008012:Lidocaine; D003000:Clonidine