Regional Anesthesia May Provide Potent Relief for Severe Raynaud’s Syndrome

Regional Anesthesia May Provide Potent Relief for Severe Raynaud’s Syndrome
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Although medical treatment is the mainstay of Raynaud’s syndrome therapy, a case report demonstrated that regional anesthesia provided temporary but potent relief from symptoms for a woman not responding to drug treatment.

The study, “Successful treatment of Raynaud’s syndrome in a lupus patient with continuous bilateral popliteal sciatic nerve blocks: a case report,” published in the journal Local and Regional Anesthesia, reported excellent results. However, authors admit that more studies are needed to investigate how repeated infusion of local anesthetics into peripheral nerves impacts Raynaud’s syndrome.

There are numerous drugs employed in the management of Raynaud’s syndrome, but some patients are not helped by medical approaches. Earlier studies show that surgically cutting nerves causing the pain and lack of circulation, as well as blocking the activity in such nerves with local anesthetics, can reduce pain and improve the blood circulation in hands and feet.

In an earlier attempt to control Raynaud’s symptoms by blocking nerve signaling, regional anesthesia only provided relief as long as the catheter administering the anesthetic was in place. When treatment stopped, the symptoms came back, and the patients in the study ultimately had the nerves cut.

Researchers at McGovern Medical School at the University of Texas Health Science Center reported a case of a 43-year-old woman with systemic lupus erythematosus. The woman had severe pain and tissue destruction caused by the lack of oxygenated blood in her feet.

The patient, who was originally admitted to the hospital for other lupus-related issues, was treated with Norvasc (amlodipine; a medication used to improve blood flow) 10 mg daily tablets, and doctors placed nitroglycerin extended release patches on the soles of her feet to dilate the blood vessels and improve oxygenation.

When the treatment did not help, doctors consulted the Acute Pain Medicine Service, as the woman’s condition was so severe that she screamed in pain when doctors touched her lower legs or feet even lightly.

As the woman was anxious — a condition that may worsen Raynaud’s symptoms — she was first treated with 2 mg of Versed (midazolam; a drug used to relieve anxiety before surgery or certain procedures) intravenously, before catheters pumping in local anesthetics were placed in both her feet.

After 30 minutes, doctors noted that the woman’s feet took on a more reddish color, and after 24 hours, she was able to stand on her feet with assistance. Doctors stopped the infusion after two days, and the woman continued walking during the rest of her hospital stay. The blue discoloration of her feet was also reduced.

Several months later, however, the woman had some toes amputated from both of her feet because they had been affected by gangrene before the procedure.

“While medical management should continue to be a front-line treatment for Raynaud’s syndrome, regional anesthesia can be useful in providing rapid dissipation of symptoms and may thus serve as a viable option for short-term management of this syndrome,” the research team wrote in their report.

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