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Continuous Regional Anesthesia and Inpatient Rehabilitation for Pediatric Complex Regional Pain Syndrome

Donado, Carolina MD*; Lobo, Kimberly MS, MPH*; Velarde-Álvarez, María Fe MD*; Kim, Joseph MA*; Kenney, Anne PT, DPT; Logan, Deirdre PhD*; Berde, Charles B. MD, PhD*

Regional Anesthesia & Pain Medicine: July/August 2017 - Volume 42 - Issue 4 - p 527–534
doi: 10.1097/AAP.0000000000000593
Pediatric Analgesia: Original Articles

Background: Evidence supports treatment of pediatric complex regional pain syndromes (CRPS) with physical and occupational therapy and cognitive-behavioral therapy. Some patients have persistent pain and/or limb dysfunction despite these treatments. We performed a retrospective study of pediatric patients with CRPS treated by continuous epidural or peripheral perineural local anesthetic infusions along with inpatient rehabilitation at Boston Children's Hospital.

Methods: After approval from the institutional review board, electronic medical records were reviewed for patients treated between September 2003 and September 2014. Primary outcomes were pain and functional scores. Data were collected at the first encounter, at follow-up visits between 4 months before and after admission, and daily while inpatient. Changes over time were assessed using Wilcoxon tests with Dunn corrections. Clinical significance of benefit or harm was assessed by the method of Jacobson and Truax. Response predictors were analyzed using linear mixed models and exploratory logarithmic regression analyses.

Results: Pain, function, and disability scores improved during hospitalization and in follow-up over a 4-month period. Seventy percent of patients achieved clinically significant benefit (56% for pain reduction and 40% increased functionality, respectively). Univariate and adjusted predictors of favorable outcome included preadmission resting Numeric Pain Rating Scale score of less than 6 (odds ratio, 5.0; P = 0.0164 and subsequent attendance at the Pediatric Pain Rehabilitation Center at Boston Children's Hospital (odds ratio, 5.0; P = 0.0206). Mean pain scores greater than 3 during the regional anesthesia infusion predicted less favorable outcome.

Conclusions: Continuous regional anesthesia may be an option to facilitate intensive rehabilitation for selected pediatric patients with CRPS. Further research should help clarify the role of regional anesthesia in a comprehensive management program.

From the *Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital; and Department of Anaesthesia, Harvard Medical School, Boston, MA; and †Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, MA.

Accepted for publication January 30, 2017.

Address correspondence to: Charles B. Berde, MD, PhD, Department of Anesthesiology, Perioperative and Pain Medicine Boston Children's Hospital, 333 Longwood Ave, Boston, MA 02115 (e-mail: Charles.Berde@childrens.harvard.edu).

The authors declare no conflict of interest.

The Sara Page Mayo Endowment for Pediatric Pain Research provided financial support for this work (through CB).

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.