Hello

I have 3 screws left in my foot following a bunion surgery in 2002 that left me with RSD. The screws have all come loose and causing my RSD to flare up big time. The x rays clearly show that the screws will need to be removed. Does anyone have any research info on Surgery and RSD. What can be done to try to keep the RSD from getting worse?

I can't get into see the surgeon until August 19th. I imagine a more important player to speak to would be the anesthetist, but I'm not sure who that will be yet.

Thanks

MsL

http://www.rsds.org/2/library/articl...ive/index.html

You'll have to scroll down the page a bit. There are 4 or 5 articles under CRPS and Surgery heading. It should help you out so you can be prepared and get the proper care before and after to prevent any spread.

Hugs,

Karen

i wood suggest getting a nerve block done b4 ur surgery

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

Dear Mike, Stacie and Karen.

Thank you all for pointing me in the right direction. I have printed the articles available on the RSDSA site, and am reviewing them today.

My pain specialist has stepped in to help me here. The problem is that I'm in Canada and there is a 3 year wait list for a surgeon under the medical system. I am going to a surgeon who practices at a private clinic (somewhat new here), it's the only way to jump the line. My pain specialist will be on vacation , then that surgeon goes on vacation. There is not much choice here and I'm definitely not going back to my original surgeon. Fortunately my doctor works at this clinic on his day off so he is able to speak with his colleagues on my behalf.

Mike I appreciate your assistance with with understanding the implications of the procedure. Unfortunately it is not a matter of being willing to have this done. One of the screws is actually working its way out of my foot so it must be done. The problem here is that none of the surgeons wanted to take me on as a patient. They have forced me to go to a pay clinic and the only surgeon who finally agreed to see me after my pain specialist begged him will only do it if I accept the risks of RSD spread. I get the feeling I'm being "screwed" again by the Canadian medical system. I will definitely take the article by Scott Rubin about the continuous regional anesthetic using clonidine with me.

I've thought about coming down to the states as my husband and I are in the process of relocating there (we just got our green cards:-)) The problem is that we are in total transition, haven't decided on a place to live yet and don't have any contacts yet with any doctors. We think we will ultimately move to Southern California, for warmth, sunshine and work opportunities.

Thank you again for your kind directions on this.

MsL

I just wanted to let you know that I have had surgery on my RSD foot. I had screws removed from a 5th metatarsol fixation about 9 or 10 months after surgery. I had them removed because they were very likely rubbing on nerves, and every time I bent my toes I could feel them scrape. The screws were way too long. I had a temporary flare and 2 LSB's done after, but I would say my RSD is not really any worse now than before the surgery, and I am very happy to have the screws out. I had a block during sugery called a popatial (spelling is not right, I'm sure). It numbed me from the knee down for at least 24 hours.