51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Sequential Neuraxial and Peripheral Nerve Catheter Strategy for Complex Regional Pain Syndrome After Neuroma Resection: A Case Report

Erica Myrick, MD; Scott Fisher, DO

University of Colorado Department of Anesthesiology

Why this matters

•Neuropathic pain after peripheral nerve injury is often opioid-refractory and disabling

•CRPS features:

•Allodynia

•Vasomotor instability

•Motor dysfunction

•Sensory abnormalities³

•Surgical patients frequently have poor analgesia and medication intolerance

•Regional anesthesia offers targeted, opioid-sparing control

Patient

•57-year-old man with CRPS of right foot

•Baseline pain 10/10 despite high-dose gabapentin

•Opioids ineffective even at high doses → discontinued

Anesthetic Strategy

•Combined spinal-epidural

•General Anesthesia

•No further systemic opioids after fentanyl used for induction

Postoperative Course

Phase 1: Epidural Analgesia

•PCEA: hydromorphone + bupivacaine

•Pain ↓ to 1/10

•significant sympathectomy following intrathecal bupivicaine evident by color change of the patient’s affected foot.

Phase 2: Transition Strategy

•POD2 epidural paused→ pain returned

•Sciatic nerve catheter placed

•15 mL 0.25% bupivacaine bolus

•0.2% ropivacaine @ 8 mL/hr

•Pain ↓ to 0/10

•Epidural removed

Discharge

•POD3 with continuous nerve block pump

Outcomes

✅ Pain: 10/10 → 0/10
✅ Opioid-free hospitalization
✅ Durable analgesia across transitions

Discussion

•CRPS pain can be controlled perioperatively without opioids

•Sequential neuraxial → peripheral strategy maintains analgesia

•Foot color change highlights sympathetic role in CRPS

Clinical Implications

This regional-first pathway may be a reproducible framework for:

•CRPS

•Opioid-refractory neuropathic pain

•High-risk pain patients undergoing limb surgery

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Sequential Neuraxial and Peripheral Nerve Catheter Strategy for Complex Regional Pain Syndrome after Neuroma Resection

Poster Presenter

Authors

Affiliations

Part of Topic