DOS 2018

DOS Kongressen 2018 · 85 A case of early diagnostics and treatment of complex regional pain syndrome (CRPS) Charlotte Hartig-Andreasen, Jytte F. Møller, Claus Möger Orthopedic Surgery, Aarhus University Hospital; Anesthesiology, Aarhus University Hospital Background: CRPS after wrist surgery is a well-known risk. It is a neurological condition requiring early diagnosis, multidisciplinary treatment including inten- sive hand therapy to avoid a chronic condition. Purpose / Aim of Study: To present a CRPS case treated with ketamine and methadone. Materials and Methods: 27-year-old man underwent wrist fusion with a dor- sal plate due to posttraumatic osteoarthritis secondarily to carpal instability. Findings / Results: Postoperatively pain was controlled with regional block. After two days the patient developed severe pain. Fentanyl and amitriptyline treatment was initiated for neuropathic pain. At day 6 the pain was intractable, and CRPS suspected. Treatment with prednisolone, calcium, alendronate and pantoprazole was started. The following two days CRPS became fulminant. Infection was excluded. Despite medical treatment pain continued to be in- tractable making intensive hand therapy impossible. At day 8 ketamine infusion in sub anesthetic doses was given with immediate effect and oral methadone started. Pain intensity reduced, discoloration diminished and hand therapy re- sumed. After 16 days reduction in ketamine was initiated. Twenty-four days after surgery, ketamine infusion was discontinued; the patient was pain free on methadone and discharged. Conclusions: Correct diagnosis and multidisciplinary treatment including an- esthesiologist, hand surgeons and intensive hand therapy was initiated immedi- ately resulting in complete remission 24 days after surgery. Ketamine infusion is not without risk, and whether ketamine should be used in acute/chronic CRPS, or in anesthetic/sub anesthetic doses remains unknown. Only few small studies exist and are inconclusive. In this case infusion of ketamine in sub anesthetic doses combined with methadone was efficacious in controlling the pain, making intensive hand therapy possible. 26 C.