Epidural Catheters: Limited by Infection Risk
Pain specialists have been trying to find ways to manage pain in patients with CRPS, as well prevent its occurrence in patients undergoing surgery. In many cases, a peripheral nerve or tunneled epidural catheter is placed preoperatively to maintain pain control in the postoperative period.
In a retrospective study published in the Clinical Journal of Pain,3 Dr Hayek and colleagues examined the effectiveness of tunneled epidural catheters to control pain and facilitate rehabilitation in patients with regional pain syndromes. They found that tunneled epidural catheters were often effective for achieving good analgesia and allowing rehabilitation, but were associated with a high risk for infection.
“Placement of externalized tunneled epidural catheter with continuous infusion of bupivacaine and fentanyl in patients with neuropathic pain (particularly CRPS) carries a significantly higher risk of infection than placement in patients with somatic pain,” the authors concluded.
Findings Highlight Need for CRPS Awareness
Both Drs Goebel and Hayek believe that the study findings highlight a need for increased awareness of CRPS. The rarity of the condition, however, makes cultivating awareness among general practitioners difficult, Dr. Goebel pointed out.
“Ideally, [general practitioners] would be aware that if their patient has severe unexplained limb pain, usually post trauma, then consider that CRPS is a rare differential [diagnosis],” Dr Goebel said.
Dr Hayek cautioned that surgeons need to be especially careful when treating post-traumatic or unexplained limb pain.
“Physicians treating patients with CRPS should be very cautious about reoperation on the affected limb — it can rekindle or exacerbate the pain, and necessary precautions such as a preoperative sympathetic block or catheter placement for perioperative pain control are usually indicated,” Dr Hayek said.
“Surgeons considering operating on a painful limb should always have (CRPS) in their differential diagnosis. And, if the indication for surgery is soft, they should probably involve someone else in consultation, such as a pain specialist,” Dr Hayek concluded.
1. Lunden LK, Kleggetveit IP, Jørum E. Delayed diagnosis and worsening of pain following orthopedic surgery in patients with complex regional pain syndrome (CRPS). Scand J Pain.11 (2016) 27-33.
2. American RSD Hope: http://www.rsdhope.org/what-is-crps1.html
3. Hayek SM, Paige B, Girgis G, et al. Tunneled epidural catheter infections in noncancer pain: increased risk in patients with neuropathic pain/complex regional pain syndrome. Clin J Pain. 2006 Jan;22(1):82-9.
This article originally appeared on Clinical Pain Advisor