Anyone ever heard of this "cause" for CRPS?
 

I wanted to throw this out to the experts and see if it's been heard of.
My PMR states that I got CRPS due to an anesthesia problem. Follow along-it's a little convoluted. I went in for a knee arthroscopy and patellar realignment. Got the IV in preop hold and anesthesia did what appears to me to be either a femoral block or an anterior sciatic block. Anyway, after a bit, I was sitting there in tears because only the lateral half of my leg was numb. She called the anesthesiologist over and she said she would "give me something to fix it." Then, the gave me a wallop of Versed, cause the lights went out. However, my PMR states that while they gave me enough anesthesia, they failed to give me adequate analgesia. Thus, I was asleep for the surgery but my nervous system felt the whole thing due to no pain control. Just taking a poll-
-anyone ever heard of this happening?
-anyone have this happen to them?
-does this sound rational?

Lori Lee

Hmmm i havent heard of this myself. Strange. But then again my pain management doc says my rsd is related to my psoriatic arthritis. Not heard that either.

Jolene

Hi Lori Lee,

Yes, I have heard of RSD following surgery due to anethesia or lack therof. It was on this forum. My RSD followed surgery,next day arm swelled up and then frozen shoulder. Wasn't diagnosed for 4=5 years. Moved to the opposite shoulder-frozen. Then back to left hand. Have full body now 12 years. Have no idea what went wrong, just know the surgeon passed me off to a rehab Dr. for pt. Let us know what you find out. Take care. and please stay we touch -we all care. Loretta Jewell

I have also heard that RSD can result from lack of proper anaesthesia. It is extremely important that when having any operation, the Anaesthetist gives you plenty of Anaesthetic to try and prevent any complications.

In my case, the RSD started after an injury (ankle sprain) but I have heard of others on this forum and others like it that have RSD from lack of proper anaesthesia during surgery. My Doctor and Physical Therapist's also believe that my RSD could have resulted because I am extremely hyper-mobile and that means that joints bend a lot further than they do in a "normal" person, thus resulting in being prone to Chronic Pain Conditions.

If it can be proven that your RSD is as a result of poor anaesthesia, I would definitely try and seek legal advice and see if you could get any help. I doubt though that it will be able to be proven that your RSD resulted from poor anaesthesia as most doctors try and pretend that they did everything right even when they know that they are in the wrong and your RSD could just be from the surgery itself.

Take care and I hope you are doing OK.

My lawyer is trying to find cases where this is true for my case against this anesthesiologist. He says that he personally has prosecuted her successfully twice for the same. Hello! However, he is looking for something solid which says that this can happen when inadequate analgesia is used. FIgured I'd throw that out there as well-you all are such a wealth of knowledge and a blessing to me.
Lori Lee

I've always wondered about this but have never heard any sort of confirmation.

I'm pretty confident the typical old line doctor would scoff at the concept.

It makes sense to me though.

I'm really good at researching and finding things on the net. I have done an exhaustive search,phrasing it every which way possible,slightly different words,etc. I can't find anything about rsd developing due to inadequate anesthesia. All I kept finding is related to getting rsd after surgery. I don't think anyone researched enough yet into the reason why rsd develops after surgery. That will be when we have an answer to the question. If rsd develops in people after surgery due to inadequate anesthesia, or if there are other reasons or a combo thereof. Personally, since no one knows exactly what "causes" rsd to happen, I suspect it's due to multiple reasons of which genetics may play a part for some. We're all individuals and each one of us may have ended up with rsd for different reasons. For instance, you develop rsd after surgery due to inadequate anesthesia, I get it because of genetics and also because of the trauma my knee suffered when I hurt it. Someone else gets it after surgery just because of the "trauma" to the body that comes with surgery. Another person may be because a nerve got nicked. I could go on and on. LOL

It is an interesting theory huh? Now if only research could develop faster and catch up with us and test out our theories to see which ones are right and which are wrong or maybe the theory is close but just a bit off.

I hope that maybe there is something out there written down that I just can't find. I know it would help you.

Hugs,

Karen

Lori Lee,

In my humble opinion it is more likely that your RSD is the result of the surgery itself, and not from the anesthesia or lack thereof. Please understand that people have developed this condition over something as simple as getting an injection (at least according to some written materials I have seen).

Best regards,

EJ

regional anesthesia
 

Dear Lori Lee -

Not one to lightly disagree with my wise friend EJ, I think there is something to what was suggested to you, but it is not so much the quantity of the anesthesia, but the quality. That said, this may not be something that rises to the level of medical malpractice, depending on how quickly the practice of "regional anesthesia" had been adopted (if at all) by anesthesiologists in your area at the time of your surgery. See, Legal Medicine (7th Ed.) by Shafeek S. Sanbar et al, 2007:

Generally, the legal standard for medical practice liability is whether a particular theory deviated from accepted medical practice in the community and if that therapy resulted in patient injury. (P. 69; emphasis added.) http://books.google.com/books?id=3tJ...um=3&ct=result

Essentially, it has only been in the few years that publicity appears to have been given to the theory of "regional anesthesia" otherwise known as "continuous regional anesthesia," which holds that even though a patient is rendered unconscious by a general anesthetic, "painful" stimuli can still be transmitted along the sensory nerves to the dorsal horn of the spine and ultimately, the brain itself, setting up the conditions out of which CRPS arises, and that this can be stopped by flooding the area subject to the surgery with local anesthetic during and 2 - 3 days after the surgery: think of it as a giant block.

For a GREAT article on the subject, written for the general reader, see, "The Painful Truth: The Iraq war is a new kind of hell, with more survivors - but more maimed, shattered limbs - than ever, a revolution in battlefield medicine is helping them conquer the pain," by Steve Silberman, Wired, Issue 13.02 - February 2005 http://www.wired.com/wired/archive/1...ain&topic_set= The story tells the tale about how one anesthesiologist from Walter Reed revolutionized the treatment of horrific battlefield injuries, all by pumping local anesthetics into the site of the wound.

And for four medical articles addressing the subject, go to the RSDSA Medical Articles Archive page at http://www.rsds.org/2/library/articl...ive/index.html and under the heading "CRPS and Surgery" click on any of the following free and full text articles:

Author: Reuben SS
Title: Preventing the Development of Complex Regional Pain Syndrome after Surgery
Source: Anesthesiology. 2004;101:1215-1224.

Author: Reuben SS, Ekman EF
Title: The Effect of Initiating a Preventive Multimodal Analgesic Regimen on Long-Term Patient Outcomes for Outpatient Anterior Cruciate Ligament Reconstruction Surgery
Source: Int Anes Res Soc. 2007;105(1):228-232.

Author: Reuben SS, Pristas R, Dixon D, Faruqi S, Madabhushi L, Wenner S
Title: The Incidence of Complex Regional Pain Syndrome After Fasciectomy for Dupuytren’s Contracture: A Prospective Observational Study of Four Anesthetic Techniques
Source: Anesth Analg. 2006;102:499-503.

Author: Reuben SS, Rosenthal EA, Steinberg RB, Faruqi S, Kilaru P
Title: Surgery on the Affected Upper Extremity of Patients with a History of Complex Regional Pain Syndrome: The Use of Intravenous Regional Anesthesia with Clonidine
Source: J Clin Anes. 2004;16:517-522.

So, bottom line, surgery on a limb without the use of a continuous regional anesthesia definitely increases the likelihood of a patient developing CRPS. But this is pretty new stuff. And did the failure to employ that technique deviate from "accepted medical practice" in your community at the time of the surgery? That's a tough one, and the stuff that law suits are made of. It's certainly not a "slam dunk" and that, like it or not, is what most tort lawyers working on a contingency are generally looking for.

Mike

Mike this really is a GREAT article! I have emailed it to my doctor in hopes that he can spread the word around here.

Thank you for this :)