Well, I had a hip replacement almost 5 years ago which put my RSD into full gear spreading to all limbs. Now my hip is hurting a lot and I am afraid I will need surgery again. I can't live with my hip the way it is. What should I ask or tell the ortho they need to do if I need surgery- Ketamine? Nerve blocks- and will that help prevent spread even though they never worked for me?? I am so distraught- Any insight would be greatly appreciated!!

Debbie

I don't have any insight but hear and understand yor fears. I guess and I am going to be probably getting a scs but I am going to ask what kind of relief will be there for me if something goes wrong. So maybe you can ask them if you do go in a flare what meds or treatments will be available? Does your ortho know a lot about rsd? If not maybe finding a doc or one of your others to inform him/her so it is like a team approach. I am sorry you have to go through this.

Hey Deb,
Remember in Nov 2005 I had back surgery (3 level fusion) & they used Ketamine during surgery & I didn't have any more spread than I already had. I have RSD in both feet & ankles. It was starting to go into my hands right before surgery but using Ketamine slowed that down. As soon as the burning & tingling started back up I hadi SGB's for 2 yrs in a row & it is just now starting to bother then a bit again. Next visit I will talk to my doctor about starting those up again. The only suggestion I have is that you have them use Ketamine. It did take me all day to wake up from it completely. Meaning surgery at 7am & finally woke up & stayed awake between 9 & 10pm. They did put me in ICU for that duration. But as soon as I woke up they sent me down to my room.

Good luck & am sorry to hear about your hip.

DebbyV

Hello,
I was supposed to have surgery in my pelvic last year but deferred due to the RSD onset. I am thinking it again but scared of the spread. May i ask how many days should i suggest to the doc for katemine infusion? Will insurance cover it?
Take care!
Numb

Dear Debbie -

This is a topic that keeps coming up, and is an important one. One of the key techniques in blocking the spread of RSD in sugery is the use of something called "continuous regional anesthesia" during the procedure. The idea is that while a genereal anesthetic knocks you out, only the application of a local to the affected area prevents the flow of pain processing signals to the dorsal horn of the spinal cord, and ultilmately the brain, which in turn may trigger greater sensitization and the spread of RSD.

A good group of articles in pdf formats on the subject appears under the heading of "CRPS and Surgery" on the RSDSA Medical Articles Archive page at http://www.rsds.org/2/library/articl...ve/index.html:

Author: Buvanendran A, Reuben SS, Kari M, Kroin JS, Della Valle C
Title: Perioperative Pregabalin Reduces Neuropathic Pain at 3 Months after Total Knee Arthroplasty (TKA)
Source: Accepted presentation abstract for the International Anesthesia Research Society Meeting, March 2008.

Author: Cramer G, Young BM, Schwarzentraub DPM, Oliva CM, Racs G
Title: Preemptive Analgesia in Elective Surgery in Patients with Complex Regional Pain Syndrome: A Case Report
Source: J Foot Ankle Surg. 2002:39:387-391.

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

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.

Author: Marx C, Wiedersheim P, Michel BA, Stucki G
Title: Preventing Recurrence of Reflex Sympathetic Dystrophy in Patients Requiring an Operative Intervention at the Site of Dystrophy after Surgery
Source: Clin Rheumatol. 2001;20:114-118.

I would definitely check them out. That said, Debby's report about using ketamine as a general anesthetic is facinating, and well worth looking into.

Mike

That is what they did I believe, a continuous infusion of ketamine in the spine altho it did take me longer than normal to wake up.

DebbyV

Thanks so much for your responses! I am going to bring those articles when I go see the ortho- I guess I am jumping the gun but there is something definately very wrong - I just hope it is fixable. I can't imagine going on like this!

Debbie

My husband is contemplating knee and shoulder surgery at Hospital for special surgery. His pain management doc, also at HSS, would be involved. They would bring him in one day before surgery for iv infusions or pain meds including ketamine and he would need to stay for 2-3 days afterwards for more iv infusions. PM doctor is encouraging about the protocols stopping the spread and preventing a flare.

Is your PM dr. by chance dr. Richman? I would love to go there but I don't think my insurance covers any orthos there.....

Thanks for your input

Debbie

One of my docs suggested avoiding all surgery at all costs. (like the axe).

He said iff necessary use an epidural.

I know nothing.