Patient presents for TKA. Has a known history of RSD following ORIF tibia on contralateral (or ipsilateral) leg. Would you do regional anesthesia and / or a spinal knowing you will be the one blamed for the development of RSD in the operative leg or spine?
CRPS I / RSD
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Not worth it!
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Does patient really have crps, per budapest criteria? Premedicated with tons of vitamin c? Opiate dependent?
If it is true CRPS then I would do this: pre medicate with vitamin C 500mg qday two weeks preop and a month post-op, avoid regional because you may get blamed for nerve injury, spinal intraop, ketamine infusion intraop and explain to the patient that it is highly possible they will have a flare vs develop CRPS following the procedure.
True CRPS is rare and a lot of what gets labeled CRPS is merely chronic post op/post injury pain.
True CRPS is rare and a lot of what gets labeled CRPS is merely chronic post op/post injury pain.
