There is a paucity of information related to treatment
of pediatric CRPS. Treatment of CRPS
in pediatric patients has been guided by adult
recommendations, which consist of a multidisciplinary
approach involving pharmacotherapy,
physical therapy, and psychotherapy, as appropriate.
Patients unable to tolerate physical therapy
with traditional oral pharmacotherapy may require
more invasive pain management techniques
such as sympathetic blocks, epidural infusion of
analgesics, or spinal cord stimulation to facilitate
restoration of function.
This case report describes the successful use
of epidural infusion of fentanyl, clonidine, and
bupivacaine through a tunneled epidural lumbar
catheter for pain management in an 11-year-old
girl who developed complex regional pain syndrome
I (CRPS I) approximately 2 months after
sustaining an injury to her right knee. Following
short-lasting pain relief from 3 repeated blocks,
she underwent an implant of a tunneled epidural
catheter (TEC) and a 4-week infusion of fentanyl
(2 mcg/mL), clonidine (1 mcg/mL), and bupivacaine
(0.04%). At last follow-up, approximately
3.5 months after implant of the TEC, the patient’s
pain and symptoms were completely resolved,
her range of motion and function were completely
restored, and her physical activity had returned to
pre-injury levels.
Key words: Complex regional pain syndrome
(CRPS), tunneled epidural catheter, pediatric,
continuous regional anesthesia, epidural analgesia,
continuous epidural anesthesia, interventional
pain management
Could the complex regional pain syndrome (Sudeck atrophy), emerged as a distal radius at the typical site fracture complication, be prevented by physical therapy?
