Abstract ID: A20
Abstract Title: Complex Regional Pain Syndrome Following Radial Artery Cannulation
Authors: Nassiri, MD MA J1, Hsu, MD MBA D2
Harbor-UCLA Medical Center Torrance CA USA1, Harbor-UCLA Medical Center Torrance CA USA2
Poster Type: Either
ABSTRACT BODY
We report with interest the development of complex regional pain syndrome following radial artery catheterization. A 57-year-old-male with diabetes mellitus, hypertension, coronary artery disease and bilateral Dupuytren’s contracture, underwent an uneventful coronary bypass graft surgery. For monitoring purposes, a 20 gauge Arrow angiocatheter was placed into his left radial artery. No technical problems were encountered. The perioperative course was uneventful and the patient was discharged home on the fourth post-operative day.
One week after surgery the patient noticed distinctive pain and swelling in his distal phalanges of left third and fourth fingers. Within several days, his pain and swelling worsened and traveled in the proximal direction affecting his entire left hand. Within weeks, he developed hyperesthesia, allondynia and hyperhidrosis over his entire left hand and distal forearm. Physical examination revealed persistent hyperesthesia, without hair loss or allodynia in the involved region. Skin over the dorsum of the thumb and all four fingers was shiny with generalized swelling of thumb, index, middle and fourth fingers. Grip strength was markedly reduced. A tentative diagnosis of complex regional pain syndrome type I was established. The patient underwent a diagnostic left stellate ganglion block with symptomatic relief followed be two theraputic blocks with almost complete relief thereafter. Currently, he has minimal pain and almost full recovery and use of his left hand.
Complex Regional Pain Syndrome (CRPS) may occur from a variety of events. The triggering agent may be as minor as a limb strain, profound as a severe crush injury or the result from chronic repetitive movement ranging from prolonged piano, keyboard use or heavy drilling.1 There have been several reports of CRPS from radial artery cannulation for coronary artery catheterization and angioplasty.2 Our patient developed CRPS I from an uncomplicated radial arterial catheterization. To the best of our knowledge, there have been no reports to date of CRPS occurring after radial artery catheterization for monitoring purposes. A high incidence (45%) of CRPS has been noted in patients after corrective surgery for Dupytrene’s contracture.3,4 Presumably, a prophylactic stellate ganglion block in patients undergoing fasciotomy for Dupytrens contracture may prevent the development of CPRS. Thus, the use of stelletate ganglion block may play a role in the prevention of CPRS in patients. Ipsilateral stellate ganglion blocks in patients that have symptoms consistent with CRPS prior to surgery on the affected upper extremity has been popularized1 This pre-emptive planning may decrease the recurrence of CRPS. We do not know whether the presence of a Dupuytren’s contracture in our patient increased the likelihood of developing CRPS I of his hand after soft tissue trauma in the form of radial artery cannulation. It is important to emphasize early recognition of symptoms and timely referral to a pain service.
References
1. Reuben, S, Preventing the Development of Complex Regional Pain syndrome after Surgery, Anesthesiology, V 101, No.5, Nov 2004.
2. Papdimos, T., and Hofmann, JP, Radial Artery Thrombosis, Palmar Arch Systolic Blood Velocities, and Chronic Regional Pain Syndrome following transradial Cardiac Catheterization., Catheterization and Cardiovascular Interventions, 57: 537-540, 2002
3. Tubiana R, Fahrer M, McCullough CJ: Recurrence and other complications in surgery of Dupuytren’s contracture. Clin Plast Surg 1981; 8: 45-50.
4. Prosser, R, conolly WB, Complications following surgical treatment for Dupuytren’s contracture. Journal Hand Therapy 1996; 9: 344-348.
ATTACHED FILES
Reg Anesth Pain Med 2005; 30(3):A20