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Reflex sympathetic imbalance

Response to epidural blockade

Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York

Kenneth E. DeHaven, MD

Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, New York

Jaimala Thanik, MD

Department of Anesthesiology, University of Rochester Medical Center, Rochester, New York

Richard B. Patt, MD

Department of Anesthesiology, University of Rochester Medical Center, Rochester, New York

Michael Feuerstein, PhD

Division of Behavioral and Psychosocial Medicine, University of Rochester Medical Center, Rochester, New York

Eleven patients (two male, nine female) were treated with epidural sympathetic blockade for reflex sympa thetic imbalance, an incomplete manifestation of reflex sympathetic dystrophy. Each had developed severe pain, sensitivity, and disability disproportionate to as sociated trauma. One patient injured an ankle, and the remaining 10 patients one or both knees (12 knees). Seven patients had undergone previous surgery. All but one had a favorable response to initial blockade. This individual eventually failed treatment despite surgical sympathectomy. Seven have required readministration of a block for clinical relapse. Mean followup was 22 months (range, 10 to 41 months). Five underwent ex tensive psychological testing. All have required adjunc tive forms of therapy including physical therapy, trans cutaneous electrical nerve stimulation (TENS), antiin flammatory or other nonnarcotic agents. Recovery is typically prolonged, particularly if the diagnosis is de layed. Close attention to, and therefore prevention of, situations that trigger its recurrence is essential for successful rehabilitation.

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