Perioperative management for patients with complex regional pain syndrome.

SUMMARY Our knowledge of complex regional pain syndrome extends from the time of the American Civil War until today. Traumatic or surgical insults can be the precipitating factors in normal patients and can therefore be significant in the exacerbation of the condition. Complex regional pain syndrome patients complain of continuing pain that is disproportionate in severity to the inciting event. The pain is usually accompanied by sensory symptoms, such as allodynia or hyperalgesia, and vasomotor changes, such as changes in color or temperature. There has been increasing research on predicting the development of postoperative complex regional pain syndrome and its prevention. Management includes sympathetic blockades, spinal cord stimulation and medications (such as anticonvulsants, antidepressants, local anesthetics, NMDA antagonists and α-2-adrenergic agonists). In the last few years, several newer medications and supplements to prevent and treat the condition have been studied.