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Ketamine as Adjunctive Anesthesia in Refractory Complex Regional Pain Syndrome Patients: A Case Series | OMICS International | Abstract
ISSN: 2165-7920

Journal of Clinical Case Reports
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Case Report

Ketamine as Adjunctive Anesthesia in Refractory Complex Regional Pain Syndrome Patients: A Case Series

Schwartzman RJ*, Samudralwar R, Getson P and Alexander GM
Department of Neurology, 245 N. 15th Street, Suite 7102, MS 423 Philadelphia, PA 19102-1192, USA
Corresponding Author : Robert J Schwartzman
Professor and Chairman
Department of Neurolog
245 N. 15th Street, Suite 7102
MS 423 Philadelphia, PA 19102-1192, USA
Tel: 215-762-7090
Fax: 215-762-3161
E-mail: [email protected]
Received July 13, 2012; Accepted August 14, 2012; Received July 13, 2012; Accepted August 14, 2012; Published August 14, 2012 August 14, 2012
Citation: Schwartzman RJ, Samudralwar R, Getson P, Alexander GM (2012) Ketamine as Adjunctive Anesthesia in Refractory Complex Regional Pain Syndrome Patients: A Case Series. J Clin Case Rep 2:186. doi:10.4172/2165-7920.1000186
Copyright: © 2012 Schwartzman RJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Complex regional pain syndrome most often follows peripheral soft tissue and nerve injury, fractures, and surgical procedures. The pain is out of proportion to the severity of the injury, spreads beyond a nerve or root territory and increases over time. In general, recommendations for anesthesia for these patients requiring surgery include sympathetic blockade or intravenous regional anesthesia as well as sympathetic blockade in conjunction with lidocaine. Quite often surgery for these patients seriously aggravates their condition. This is a retrospective evaluation of a case series of the use of ketamine as adjunctive anesthesia in twenty five refractory long standing complex regional pain syndrome patients. All patients met the International Association for the Study of Pain criteria for diagnosis. Ketamine was administered intravenously over four hours from the start of the procedure with midazolam and clonidine in addition to their standard anesthesia. At the end of the procedure, an additional dose of midazolam was administered. Lorazepam was used for restlessness if necessary for three nights after the procedure. All twenty five patients had no exacerbation of their symptoms and signs and no spread of their CRPS. This study supports the effective use of ketamine, midazolam and clonidine as adjunctive anesthesia in severe refractory CRPS patients undergoing a surgical procedure.


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