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

  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},
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.

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.

Intravenous Therapies for Complex Regional Pain Syndrome: A Systematic Review

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.

Complex Regional Pain Syndrome

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.

Treatment of complex regional pain syndrome: an updated systematic review and narrative synthesis

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.

Interventional Treatment of Complex Regional Pain Syndrome

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.

Treatment of complex regional pain syndrome in adults: A systematic review of randomized controlled trials published from June 2000 to February 2012

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.

The Efficacy of Systemic Lidocaine in the Management of Chronic Pain: A Literature Review

Intravenous lidOCaine and lidocaine patch are effective and safe for the treatment of several chronic or neuropathic pain syndromes and the use of lidocane during surgery could prevent the development of some chronic post-surgical pain syndroma.


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.

Pharmacotherapeutic options for complex regional pain syndrome

In the opinion, drug therapy should be preferred as early as possible, particularly in warm forms of CRPS to prevent significant functional limitation, psychological distress, and social and economic fallout.



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It is concluded that the combination of bretylium and lidocaine is significantly more effective than lidocane alone when an intravenous block is used to treat reflex sympathetic dystrophy.

Intravenous regional block using ketorolac: preliminary results in the treatment of reflex sympathetic dystrophy.

Ketorolac could be effective in treating RSD by IVRBs in a manner similar to steroids but with relatively fewer side effects, and was given using IVRB technique.

Comparison of Intramuscular Ketorolac Tromethamine and Morphine Sulfate for Analgesia of Pain After Major Surgery

Patients with pain related to major surgery were better able to distinguish analgesic potency of morphine than those having less traumatic procedures, and ketorolac 90 mg was more effective than morphine 12 mg during the entire 6 hours.

Comparison of intramuscular ketorolac and morphine in pain control after laparotomy

It is concluded that ketorolac can provide effective postoperative analgesia and pain‐relief scores were better in the morphine group.

Ketorolac and acetaminophen for orthopedic postoperative pain

The higher doses of ketorolac induced a longer lasting peak analgesic effect than did acetaminophen, but the magnitude of the peak pain relief was changed little by an increased ketorlac dose.

Comparison of i.m. ketorolac trometamol and morphine sulphate for pain relief after cholecystectomy.

Kentonolac produced significantly less analgesia than morphine on day 1, but on day 2 the two drugs produced a similar effect, and blood loss was not increased by ketorolac, although platelet function was impaired.

Ketorolac tromethamine as compared with morphine sulfate for treatment of postoperative pain

Ketorolac tromethamine was shown to be a safe and effective analgesic for relief of postoperative pain and there were no serious side effects reported.

Case series: IV regional anesthesia with ketorolac and lidocaine: is it effective for the management of complex regional pain syndrome 1 in children and adolescents?

The experience with ketorolac/lidocaine IV regional anesthesia (Bier block) (IVRA) in two adolescents with complex regional pain syndrome resulted in complete resolution of symptoms.

Treatment of complex regional pain syndrome: a review of the evidence

The available evidence does not support the use of calcitonin, vasodilators, or sympatholytic and neuromodulative intravenous regional blockade, and clear benefits have not been reported with stellate/lumbar sympathetic blocks, mannitol, gabapentin, and physical/occupational therapy.