Zyluk Andrzej
Klinika Chirurgii Ogólnej i Chirurgii Reki, Pomorska Akademia Medyczna w Szczecinie.
Chir Narzadow Ruchu Ortop Pol. 2009 Sep-Oct;74(5):260-5.
The results of the treatment of 9 patients, exclusively women, suffering from chronic CRPS Type 1 involving lower limb and lasting a mean of 13 months are reported. Foot and ankle was involved in 5 cases and knee in four. The treatment consisted in 7 days course of epidural anaesthesia with 0.25% bupivacaine. Continuos epidural infusion was performed by a pump, with flow in average 4 ml per hour, and intensity of the flow was matched to achieve sufficient anaesthesia, but none, or minimal muscle paralysis, in order to allow patients to bear their legs or to walk on crutches. The results were assessed twice: immediately after the treatment was completed and at a mean of 20 months later. Pain at rest and at loading of the extremity, CRPS score and ability of walking were considered. Results. Of the 9 patients, three can be considered recovered, self-walking, although still complaining of residual, intermittent pain. Next three patients had moderate symptoms and were able to walk only on crutch or crutches, and next in one the disease recurred and was the same severe as before treatment. In two other patients treatment was temporarily effective for a mean of 2.5 months and then symptoms and signs recurred. These patients over a three-years period underwent 7 and 8 treatments, respectively.
Continuos epidural anaesthesia with bupivacaine for 7 days is a moderately effective treatment for chronic CRPS Type 1 of the lower limb, recommended particularly when long-lasting therapy fails to improve and patient is unable to walk on the involved extremity.
报告了9例仅为女性的慢性1型复杂性区域疼痛综合征（CRPS）患者的治疗结果，这些患者累及下肢，病程平均为13个月。5例累及足和踝，4例累及膝。治疗采用0.25%布比卡因进行为期7天的硬膜外麻醉。通过泵进行持续硬膜外输注，平均流速为每小时4毫升，流速强度根据实现充分麻醉但无或仅有轻微肌肉麻痹的情况进行调整，以便患者能够支撑腿部或使用拐杖行走。结果评估了两次：治疗结束后立即评估以及平均20个月后评估。评估指标包括静息和肢体负重时的疼痛、CRPS评分以及行走能力。结果：9例患者中，3例可视为康复，能够自行行走，尽管仍抱怨有残留的间歇性疼痛。接下来的3例患者症状中等，仅能使用一根或多根拐杖行走，还有1例疾病复发，病情与治疗前一样严重。另外2例患者治疗的平均有效时长为2.5个月，之后症状和体征复发。这两名患者在三年期间分别接受了7次和8次治疗。
使用布比卡因进行7天的持续硬膜外麻醉是治疗下肢慢性1型CRPS的一种中等有效的治疗方法，尤其推荐用于长期治疗无效且患者无法在受累肢体上行走的情况。
