A Unique Presentation of Complex Regional Pain Syndrome Type I Treated with a Continuous Sciatic Peripheral Nerve Block and Parenteral Ketamine Infusion: A Case Report


Anthony Plunkett, MD, Walter Reed Army Medical Center, Anesthesia and Operative Services, 6900 Georgia Avenue, NW, Washington, DC, WA 20307, USA. Tel: 202-782-2929; Fax: 202-782-5066; E-mail: anthonyplunkett@comcast.net


Objective.  To successfully treat a patient with complex regional pain syndrome, refractory to standard therapy, to enable a rapid and full return to professional duties.

Setting.  This case report describes the rapid resolution of an unusual presentation of complex regional pain syndrome type I after four days of treatment with a continuous sciatic peripheral nerve block and a concomitant parenteral ketamine infusion. The patient was initially diagnosed with complex regional pain syndrome (CRPS) I of the right lower extremity following an ankle inversion injury. Oral medication with naproxen and gabapentin, as well as desensitization therapy, failed to provide any relief of her symptoms. She was referred to the interventional pain management clinic. A lumbar sympathetic block failed to provide any relief. The patient was diagnosed with CRPS I and was admitted for treatment with a continuous peripheral nerve block and parenteral ketamine.

Conclusion.  This case suggests therapeutic benefit from aggressive treatment of both the peripheral and central components of CRPS.