[Results of the treatment of chronic complex regional pain syndrome type 1 of the lower limb by continuous epidural anaesthesia with bupivacaine].

UNLABELLED: The results of the treatment of 9 patients, exclusively women, suffering from chronic CRPS Type 1 involving lower limb and lasting a mean of 13 months are reported. Foot and ankle was involved in 5 cases and knee in four. The treatment consisted in 7 days course of epidural anaesthesia with 0.25% bupivacaine. Continuos epidural infusion was performed by a pump, with flow in average 4 ml per hour, and intensity of the flow was matched to achieve sufficient anaesthesia, but none, or minimal muscle paralysis, in order to allow patients to bear their legs or to walk on crutches. The results were assessed twice: immediately after the treatment was completed and at a mean of 20 months later. Pain at rest and at loading of the extremity, CRPS score and ability of walking were considered. Results. Of the 9 patients, three can be considered recovered, self-walking, although still complaining of residual, intermittent pain. Next three patients had moderate symptoms and were able to walk only on crutch or crutches, and next in one the disease recurred and was the same severe as before treatment. In two other patients treatment was temporarily effective for a mean of 2.5 months and then symptoms and signs recurred. These patients over a three-years period underwent 7 and 8 treatments, respectively.

CONCLUSION

Continuos epidural anaesthesia with bupivacaine for 7 days is a moderately effective treatment for chronic CRPS Type 1 of the lower limb, recommended particularly when long-lasting therapy fails to improve and patient is unable to walk on the involved extremity.