• Mauricio Forero, Rami A Kamel, Philip Lung Chan, and Eugene Maida.
• Anesthesia, McMaster University Michael G DeGroote School of Medicine, Hamilton, Canada Maoforeroman@hotmail.com.
• Reg Anesth Pain Med. 2022 Jul 1; 47 (7): 434-436.

BackgroundRecalcitrant complex regional pain syndrome (CRPS) type 1 is a devastating condition.Case PresentationWe report a case of a patient in their twenties with left hand and forearm CRPS type I, transiently responsive to spinal cord stimulation, thoracic sympathectomy, and multimodal analgesia. The investigators initiated a trial of a single-shot erector spinae plane block at the T2 level, resulting in a clinically significant improvement in pain, function, vasomotor and sudomotor symptoms transiently for a 36-hour interval. As a result, a permanent e-port catheter implantation under combined ultrasound and fluoroscopic guidance was trialed. Two-year follow-up of the continuous erector spinae plane block (CESPB) indicated an 80% reduction in pain scores from baseline, and a 50% reduction in opiate consumption, with a clinically significant reduction in swelling, color changes, allodynia, and temperature asymmetry.ConclusionRecalcitrant CRPS type 1 is a challenging life-altering condition that results in a cyclical triad of chronic pain, disability, and impaired psychosocial health. The profound and prolonged analgesic response to CESPB, highlights the clinical utility of this technique, and warrants more clinical investigation.© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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