Pediatric Continuous Brachial Plexus Catheter for a Case of Complex Regional Pain Syndrome (CRPS)

Reda Tolba,Maged Guirguis,Loran Mounir Soliman,Rhamee Badr

doi:10.4236/ojanes.2015.51001

Reda Tolba, Maged Guirguis + Show 2 more

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https://doi.org/10.4236/ojanes.2015.51001

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Abstract

Introduction: Complex regional pain syndrome (CRPS) is a disorder characterized by pain as well as a myriad of sensory, autonomic, and motor disturbances. We are reporting a case of child diagnosed with CRPS and successfully treated with supraclavicular brachial plexus catheter infusion of local anesthetic. Case Report: An eight-year-old male underwent a left thoracotomy, repair of esophageal vascular ring, and translocation of the left subclavian to the left carotid artery. Post-operative course was relevant for severe intractable left shoulder and left arm pain associated with allodynia and hyperalgesia. A supraclavicular catheter was inserted, and an infusion of ropivacaine 0.2% was started. The child was sent for physical therapy as he gradually regained all functions of his left arm and resumed his regular activities. Conclusion: Continuous supraclavicular brachial plexus catheter infusion of local anesthetic is a valuable method of reducing pain in severe cases of upper extremity pediatric CRPS and may be safer and more effective than other invasive measures such as sympathetic blocks and epidural catheterization. Further research surrounding the diagnosis and treatment of pediatric CRPS is needed to allow early diagnosis and treatment and to improve outcome.

Highlights

Complex regional pain syndrome (CRPS) is a disorder characterized by pain as well as a myriad of sensory, autonomic, and motor disturbances
Complex regional pain syndrome (CRPS) is a disorder characterized by pain, as well as a myriad of sensory, How to cite this paper: Tolba, R., Badr, R., Guirguis, M. and Soliman, L.M. (2015) Pediatric Continuous Brachial Plexus Catheter for a Case of Complex Regional Pain Syndrome (CRPS)
Conservative treatment modalities include physical therapy, behavioral therapy and management with opioids and membrane stabilizers. More invasive approaches such as transcutaneous electrical nerve stimulation (TENS), sympathetic blocks, tunneled epidural catheters, regional nerve blocks, as well as more aggressive surgical approaches may be necessary in recalcitrant cases. In this case we report the use of supraclavicular brachial plexus catheter continuous infusion for the treatment of upper extremity CRPS in an 8-year-old child

Summary

Introduction

Complex regional pain syndrome (CRPS) is a disorder characterized by pain, as well as a myriad of sensory, How to cite this paper: Tolba, R., Badr, R., Guirguis, M. and Soliman, L.M. (2015) Pediatric Continuous Brachial Plexus Catheter for a Case of Complex Regional Pain Syndrome (CRPS). (2015) Pediatric Continuous Brachial Plexus Catheter for a Case of Complex Regional Pain Syndrome (CRPS). Conservative treatment modalities include physical therapy, behavioral therapy and management with opioids and membrane stabilizers More invasive approaches such as transcutaneous electrical nerve stimulation (TENS), sympathetic blocks, tunneled epidural catheters, regional nerve blocks, as well as more aggressive surgical approaches may be necessary in recalcitrant cases. In this case we report the use of supraclavicular brachial plexus catheter continuous infusion for the treatment of upper extremity CRPS in an 8-year-old child. This case study details how continuous supraclavicular brachial plexus catheter infusion of local anesthetic for 7 days helped control the child’s pain and allowed for the initiation and maintenance of physical therapy with the eventual restoration of the patient’s normal activity level

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