Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: The use of intravenous regional anesthesia with clonidine

Abstract

Study objectives To evaluate the efficacy of intravenous regional anesthesia (IVRA) with clonidine in patients with a previous history of complex regional pain syndrome (CRPS) who are undergoing upper extremity hand surgery. Design Prospective, randomized, double-blind study. Setting Operating suites and Pain Management Center of a large university-affiliated medical center. Patients 84 patients with a previous history of upper extremity CRPS undergoing surgery on the affected extremity. All signs and symptoms of CRPS had resolved prior to the time of surgery. Interventions Patients were randomized to receive IVRA with 0.5 % lidocaine with either 1 mL normal saline (n = 42) or clonidine 1 μg/kg (n = 42) added to the lidocaine solution. Measurements Recurrence of CRPS symptoms at 1 year following surgery were recorded. Main results The recurrence rate of CRPS was significantly lower ( p < 0.001) in those patients receiving IVRA with lidocaine and clonidine (10%, n = 4) compared with those patients receiving IVRA lidocaine only (74%, n = 31). Conclusions Intraoperative IVRA with lidocaine and clonidine on patients with a history of CRPS can significantly reduce the recurrence rate of this disease process.