Everett Adam, Mclean Brian, Plunkett Anthony, Buckenmaier Chester
Walter Reed Army Medical Center-Army Regional Anesthesia & Pain Medicine, Washington, DC 20307, USA.
Pain Med. 2009 Sep;10(6):1136-9. doi: 10.1111/j.1526-4637.2009.00684.x. Epub 2009 Sep 9.
To successfully treat a patient with complex regional pain syndrome, refractory to standard therapy, to enable a rapid and full return to professional duties.
This case report describes the rapid resolution of an unusual presentation of complex regional pain syndrome type I after four days of treatment with a continuous sciatic peripheral nerve block and a concomitant parenteral ketamine infusion. The patient was initially diagnosed with complex regional pain syndrome (CRPS) I of the right lower extremity following an ankle inversion injury. Oral medication with naproxen and gabapentin, as well as desensitization therapy, failed to provide any relief of her symptoms. She was referred to the interventional pain management clinic. A lumbar sympathetic block failed to provide any relief. The patient was diagnosed with CRPS I and was admitted for treatment with a continuous peripheral nerve block and parenteral ketamine.
This case suggests therapeutic benefit from aggressive treatment of both the peripheral and central components of CRPS.
成功治疗一名对标准治疗无效的复杂性区域疼痛综合征患者，使其迅速全面恢复工作职责。
本病例报告描述了一名I型复杂性区域疼痛综合征患者在接受连续坐骨神经周围神经阻滞和静脉注射氯胺酮四天后，其异常表现迅速得到缓解。患者最初因踝关节内翻损伤被诊断为右下肢I型复杂性区域疼痛综合征（CRPS）。服用萘普生和加巴喷丁的口服药物以及脱敏治疗均未能缓解其症状。她被转诊至介入疼痛管理诊所。腰交感神经阻滞也未能缓解症状。患者被诊断为I型CRPS，并住院接受连续周围神经阻滞和静脉注射氯胺酮治疗。
本病例表明，积极治疗CRPS的外周和中枢成分均具有治疗益处。
