Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: the use of intravenous regional anesthesia with clonidine.

STUDY OBJECTIVES: To evaluate the efficacy of intravenous regional anesthesia (IVRA) with clonidine in patients with a previous history of complex regional pain syndrome (CRPS) who are undergoing upper extremity hand surgery. DESIGN: Prospective, randomized, double-blind study. SETTING: Operating suites and Pain Management Center of a large university-affiliated medical center. PATIENTS: 84 patients with a previous history of upper extremity CRPS undergoing surgery on the affected extremity. All signs and symptoms of CRPS had resolved prior to the time of surgery. INTERVENTIONS: Patients were randomized to receive IVRA with 0.5 % lidocaine with either 1 mL normal saline (n=42) or clonidine 1 microg/kg (n=42) added to the lidocaine solution. MEASUREMENTS: Recurrence of CRPS symptoms at 1 year following surgery were recorded. MAIN RESULTS: The recurrence rate of CRPS was significantly lower (p <0.001) in those patients receiving IVRA with lidocaine and clonidine (10%, n=4) compared with those patients receiving IVRA lidocaine only (74%, n=31). CONCLUSIONS: Intraoperative IVRA with lidocaine and clonidine on patients with a history of CRPS can significantly reduce the recurrence rate of this disease process.