Department of Anesthesiology, National Defense Medical College, Tokorozawa, Saitama, Japan.
Pain Med. 2010 Feb;11(2):274-80. doi: 10.1111/j.1526-4637.2009.00777.x.
To present a case of complex regional pain syndrome (CRPS) type II with sympathetic dysfunction and trophic changes in the orofacial region, which was partially responsive to intravenous ketamine.
The patient was a 68-year-old man who suffered from inveterate pain with trophic changes of the right face and tongue and vasomotor dysfunction on the right side of the face after ipsilateral trigeminal nerve block. Allodynia and hyperalgesia were observed on the affected side of the face. Pain initially improved after sympathetic nerve block, but similar pain returned that was unresponsive to the same procedure. Repeated intravenous administration of low-dose ketamine preceded by intravenous midazolam alleviated the pain, but trophic changes of the tongue persisted.
CRPS in the orofacial region has not been clearly defined and has been infrequently documented. Clinical findings in this patient met the criteria of the International Association for the Study of Pain's and Harden's diagnostic criteria for CRPS. The reason for gradual pain relief after induction of intravenous ketamine therapy was unclear, but the fact that only ketamine and not other various pain medicines or procedures alleviated the pain is important to note.
Distinct cases of CRPS involving the orofacial region are rare. Thorough observations and documentation of signs and symptoms may lead to future standardization of diagnostic criteria and treatment strategies for this disorder.
报告一例伴有交感神经功能障碍和营养改变的Ⅱ型复杂性区域疼痛综合征（CRPS）病例，该病例对静脉注射氯胺酮部分有反应。
患者为 68 岁男性，在同侧三叉神经阻滞后患顽固性疼痛、右侧面部和舌部营养改变以及面部血管运动功能障碍。面部受累侧有感觉过敏和痛觉过敏。交感神经阻滞后疼痛最初有所改善，但相同的程序再次出现类似的疼痛且无反应。重复静脉给予小剂量氯胺酮，预先静脉给予咪达唑仑，可缓解疼痛，但舌部营养改变持续存在。
面部 CRPS 尚未明确界定，且很少有文献记载。该患者的临床发现符合国际疼痛研究协会和 Harden 诊断 CRPS 的标准。静脉注射氯胺酮诱导后疼痛逐渐缓解的原因尚不清楚，但值得注意的是，只有氯胺酮而不是其他各种止痛药或程序可以缓解疼痛。
涉及口腔面部的 CRPS 罕见。彻底观察和记录体征和症状可能有助于未来对此类疾病的诊断标准和治疗策略进行标准化。
