Hey Lottie

Thanks for post. Sorry for the confusion and less than complete details about the exact issue. I am hesitant to post too many specifics online for slight fear someone may recognize my case, me, etc, and it affects my care. Doc's, nurses, insurance, etc. I mean. I know how unlikely it is but you never know.

To answer your questions:

Situation:
1. A patient (let's say me, for argument, lol) has existing RSD in upper limb (hand/wrist) and in leg 20 plus years, both caused by surgery. RSD is on same side of body.
2. Patient is having surgery on lower limb/hip not currently affected/inflicted with RSD.
3. Surgical team is planning on doing spinal epidural/anesthesia for surgery and post op pain medications. But as far as patient knows, no nerve blocks or care for existing RSD sites to prevent spread.
4. Patient is curious about pre-emptive measures that could/should be used to prevent spread to existing sites (arm/leg). Patient assumes existing RSD leg should be ok/protected because of the spinal. Spinal should possibly help prevent RSD flare in existing RSD site and "potentially" prevent RSD from happening to anticipated/new surgical site (hip).
5. Patient thinks that pre-emptive measures, blocks, epidural, IV or something PRE operatively, multiple modalities would reduce the chances of RSD even more. That calming the body down well before surgery is helpful, useful. Whether that is a block for the RSD arm, or anesthesia, injections/blocks to settle the body.
6. By pre-emptive we are talking about not just 20 mins before surgery but hours, or days (if medication would help reduce body's poor response to surgical intervention) whatever the protocol is.
7. Would you all feel comfortable only having spinal epidural/IV anesthesia for surgery and it would potentially stay in post op a few days but no other PRE-EMPTIVE blocks?
8. Patient has a letter from treating PM doc from several years back stating that for this patient, aggressive pre, and post anesthesia, blocks should or "could" be used to reduce chances of spread of new RSD etc. In this letter, multiple block types are mentioned as well as other things such as IV lidocaine or ketamine if it is needed (loosely written - as a sort of last resort)
9. The letter will not be followed by anesthesia dept, only some of it will but it seems none of the pre-emptive measures would be used.
10. PM doc seems to be backing down from his own letter and processes now that it is getting closer. He is aligned/works with the hospital and surgeon where patient is going so it makes no sense to back down from the letter and not try to give the patient same as what is in the letter.
11. The blocks patient was curious about would be whatever block is generally used on that part of that body such as Stellate GB or Lumbar SB etc. Patient was just told NO BLOCKS are planned for upper body. Not sure if they planned on blocks for lower body other than spinal. Here is a whole article about different blocks (not specific to RSD but useful info). http://prc.coh.org/ComRegNB.pdf

Thoughts: Perhaps they just don't worry about or block upper body if you are having lower limb surgery and have regional anesthesia and epidural for lower body. Maybe they think that is enough to reduce chance of spread from lower to upper because it is anesthetized?


As for medical literature, yes there are studies or articles about the use of pre-emptive analgesia to help reduce chance of spread. Unfortunately a lot of the stuff was written or re-posted with the findings from Dr Scott Reuben who has been outed by the medical community and accused of fraud.

Some links are here to other articles: Pub Med has some articles but I can't access them. These are not ideal but they do touch on the points. Especially the first one.

http://www.rsds.org/pdfsall/cramer_et_al.pdf

http://www.rsds.org/pdf/SportsInjuryBrochure.pdf

http://www.aspmn.org/Conference/docu...isarudolph.pdf

http://www.rsds.org/education/CRPS%2...-%20Chopra.pdf

Is this helpful or even more confusing? It would be great help to so many here I bet if there was a set post or thread that stays up all the time about RSD and surgery because I think so many people fear it, or don't have the right support or know what to do. End even when they do (like me) it is really hard to get the care and protocols to actually happen. Many docs/surgeons and even PM's when it comes down to it, push comes to shove, will tell you there is not set protocol (I understand that but...) but then on the other hand, tell you blocks are useful to prevent spread. Confusing. YES. Talk and action are two different things. I have seen them talk the talk but not walk the same line to get you care you need. Probably fear of law suit, hands tied by others in charge, insurance issues, more so maybe not a standard protocol for that surgery so it is hard to get. And plenty of hospitals say they are not really experience in xyz (blocks). How anesthesiologists are not well trained and versed in blocks etc is beyond my comprehension.

Thanks again,
Sigh... time to think about happy thoughts and smile. And pray!!