title: The incidence of complex regional pain syndrome after fasciectomy for Dupuytren's contracture: a prospective observational study of four anesthetic techniques.
abstract: The development of complex regional pain syndrome (CRPS) is not an uncommon complication after Dupuytren's surgery. Despite increasing research interest, little is known regarding which patients are at increased risk for developing CRPS and what is the optimal perioperative treatment strategy for preventing the occurrence of this disease after surgery. We prospectively evaluated the use of four anesthetic techniques (general anesthesia, axillary block, and IV regional anesthesia [IVRA] with lidocaine with or without clonidine) for patients undergoing fasciectomy for Dupuytren's contracture. All patients were followed in the Pain Management Center at 1, 3, and 12 mo postoperatively by a blinded physician to evaluate the presence of CRPS. Significantly (P < 0.01) more patients developed postoperative CRPS in the general anesthesia group (n = 25; 24%) and the IVRA lidocaine group (n = 12; 25%) compared with either the axillary block group (n = 5; 5%) or the IVRA lidocaine and clonidine group (n = 3; 6%). We conclude that axillary block or IVRA with clonidine offers a significant advantage for decreasing the incidence of CRPS compared with either IVRA with lidocaine alone or general anesthesia for patients undergoing Dupuytren's surgery.
authors.affiliation: Department of Anesthesiology, Baystate Medical Center, Springfield, Massachusetts 01199, USA. scott.reuben@bhs.org
authors.forename: Scott S
authors.initials: SS
authors.lastname: Reuben
authors.forename: Rene
authors.initials: R
authors.lastname: Pristas
authors.forename: Duane
authors.initials: D
authors.lastname: Dixon
authors.forename: Shameema
authors.initials: S
authors.lastname: Faruqi
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Madabhushi
authors.forename: Steven
authors.initials: S
authors.lastname: Wenner
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods*; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D001132:Arm; D001365:Axilla; D003000:Clonidine; D020918:Complex Regional Pain Syndromes / Q000209:etiology* / Q000517:prevention & control; D004387:Dupuytren Contracture / Q000601:surgery*; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D011183:Postoperative Complications / Q000517:prevention & control; D014111:Tourniquets
chemical_list: D008012:Lidocaine; D003000:Clonidine