I agree with Karen. Continuous regional anesthesia is an incredible advance that an Army Lt. Col MD made famous on the battlefield in Iraq. The basic theory is that while general anesthesia prevents the perception of pain in the brain, it does nothing to prevent the transmission of pain of pain signals to - I believe - the dorsal horn in the spinal cord, which in turn triggers a cascade of pain sensitization resulting in a "rekindling" of the CRPS.

Of the articles that Karen refers to, the best are by Scott Reuben, who appears to concluded that by and in large, the best result is achieved with continuous regional anesthetic using clonidine. I would refer you to the most recent, "The Incidence of Complex Regional Pain Syndrome After Fasciectomy for Dupuytren’s Contracture: A Prospective Observational Study of Four Anesthetic Techniques," Reuben SS, Pristas R, Dixon D, Faruqi S, Madabhushi L, Wenner S, Anesth Analg, 2006; 102: 499-503, which you can directly link to here: http://www.rsds.org/2/library/articl...stas_Dixon.pdf

[Translation: Dupuytren's contracture refers to a painless thickening of the connective tissue in the hand that can lead to difficulty extending the fingers and fasciectomy is the surgical correction of that condition.]

In that article, the issues of blocks in place of continuous regional anesthesia is explicitly considered, and Reuben et al make the point that:

Although the regional sympatholysis provided by a stellate ganglion block may be beneficial in reducing CRPS, it requires clinical expertise and may result in significant morbidity, including vertebral artery injection, subarachnoid, or epidural block, and pneumothorax. Further, stellate ganglion blocks frequently do not produce complete sympathetic interruption of the ipsilateral upper extremity.

With foot sugery, it's my limited understanding the alternative would be a lumbar sympathetic block, as opposed to a stellate ganglion block, but in any event, the analysis could well be the same, at least with respect to the inability of the block to produce "complete sympathetic interruption."

MsL your intuition is entirely correct, that the key player in all of this is the anesthesiologist. Unfortunately, the problem at least in most U.S. hospitals is that they aren't assigned until that day before the scheduled surgery. I think your best bet is to print out Reuben's articles from the RSDSA Medical Articles Archive page that Karen linked to, take them with you when you go into see the surgeon, and the tell said surgeon that you're willing to have the procedure done if and only of it can be set up with continuous regional anesthetic, preferably using clonidine. Then let s/he make the arrangements, consulting with a pain specialist if any resistence is encountered along the way.

Good luck.

Mike