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

"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. "

Hi Mike,

Great article. This is the same technique I was given following my surgery in Germany this past summer. I had the pump going continuously for 1 week. German doctors consider this the "gold standard" for treating newly diagnosed RSD cases and have been using it with great success for years (they call it a peridural anesthesia for the lower limbs). For the upper limbs my doctor said that they can access the nerves through a spot somewhere in the neck area. I'm happy to see that it is finally making its way to North American hospitals because it will make a huge difference.

MsL

Excellent information Mike!

I stand corrected...

EJ