Anesthetic Management of a Complex Regional Pain Syndrome (CRPS) Patient With Ketamine

Complex regional pain syndrome (CRPS) is a potentially debilitating form of neuropathic pain that may manifest following a traumatic injury or surgery. CRPS is also known as algodystrophy, causalgia, or reflex sympathetic dystrophy (RSD). Patients describe unbearable burning pain from nonnociceptive stimuli, such as when taking a shower or brushing against another object. Regular tactile stimuli encountered during routine dental procedures may not be well-tolerated by a patient with CRPS. Ketamine infusions have been reported to help alleviate acute exacerbations or "flare-ups" of CRPS symptoms. This case report provides a brief overview of CRPS pathophysiology and treatment including data supporting the use of ketamine infusions and a discussion regarding the anesthetic management of a patient with CRPS presenting for dental care under deep sedation utilizing high-dose intravenous ketamine.