Intravenous Regional Ketorolac and Lidocaine in the Treatment of Complex Regional Pain Syndrome of the Lower Extremity: A Randomized, Double-blinded, Crossover Study

@article{Eckmann2011IntravenousRK,
  title={Intravenous Regional Ketorolac and Lidocaine in the Treatment of Complex Regional Pain Syndrome of the Lower Extremity: A Randomized, Double-blinded, Crossover Study},
  author={Maxim S Eckmann and Somayaji Ramamurthy and James G Griffin},
  journal={The Clinical Journal of Pain},
  year={2011},
  volume={27},
  pages={203–206}
}
Background and ObjectivesIntravenous regional blocks (IVRBs) with ketorolac and lidocaine have been reported to be useful in the treatment of complex regional pain syndrome (CRPS). This is the first controlled prospective study of IVRB with lidocaine and ketorolac for treatment of pain and edema in CRPS of the lower extremity in adults. MethodsA prospective, randomized, double-blinded, crossover design was used. The primary outcome was overall pain numeric rating scale (NRS) at 1 week… 

Complex regional pain syndrome in a patient with muscular dystrophy.

TLDR
An adolescent patient with Becker muscular dystrophy who exhibited complex regional pain syndrome type I (CRPS I) in both lower extremities that developed after instrumentation for scoliosis, together with bilateral achilloplasty is described.

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There is evidence to support the use of IV bisphosphonates, immunoglobulin, ketamine, or lidocaine as valuable interventions in selected patients with CRPS, however, high-quality studies are required to further evaluate the safety, efficacy, and cost-effectiveness of IV therapies for CRPS.

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Patients with clinical signs and symptoms of CRPS after an injury should be referred immediately to a physician with expertise in evaluating and treating this condition, including physical therapy, psychological support, and pain-relieving measures.

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An updated review of the evidence pertaining to the treatment of CRPS derived from recent randomized-controlled trials (RCTs) found that published trials continue to support the use of bisphosphonates and short courses of oral steroids in the setting ofCRPS.

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This chapter focuses on the clinical evidence of efficacy of the interventional therapies for CRPS, as well as the essential skills in clinical practice of these interventions.

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TLDR
The observed phenomenon of excellent responses in CRPS subgroups would support the case for a network‐ and multi‐centre approach in the conduct of future clinical trials and the heterogeneity of trialled interventions militate against drawing clear conclusions about the clinical usefulness of most interventions.

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The aim of this review is to show the epidemiology and etiology, proposed pathophysiological mechanisms, method of diagnosis and treatment options, prevention and mitigation of this under-recognized disease.

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