ABSTRACT
Complex regional pain syndrome (CRPS) is a collection of signs and symptoms that most often include regional pain, edema, changes in skin temperature, increased skin sensitivity, and weakness that usually affects the extremities. It almost always exclusively affects the surgical site. A 52 year old woman presented with lower extremity CRPS due to positioning after a craniotomy.
Subject(s)
Causalgia/etiology , Causalgia/therapy , Craniotomy/adverse effects , Postoperative Complications/therapy , Autonomic Nerve Block , Brain Neoplasms/surgery , Electromyography , Female , Humans , Lower Extremity , Middle Aged , Monitoring, Intraoperative , Nervous System Diseases/etiology , Nervous System Diseases/therapyABSTRACT
Perioperative management of opioid-dependent patients can be a challenge to surgeons, anesthesiologists and pain specialist. Our case illustrates the consequences of poor management of this subset of patients. A 60-year-old male with history left renal mass was scheduled for a left open nephrectomy. Preoperative pain medications included fentanyl 50 mcg every 72 hours plus hydromorphone 4mg PO PRN for breakthrough pain. An epidural was placed for post-operative pain control, and opioids were discontinued during hospitalization. Forty-eight to seventy-two hours after surgery, the patient developed withdrawal symptoms. Home medications were restarted and symptoms resolved.
