Background: Invasive procedures such as nerve blocks are used in children to facilitate PT/OT and are important in the management of CRPS; however, their relationship to physical medicine approaches is poorly delineated. The goal of this case report is to illustrate successful treatment of a patient with recalcitrant CRPS involving the distal leg with use of a specific peripheral nerve block and coordinated PT/OT while in the inpatient setting. We are unaware of previous reports of a major nerve block combined with PT/OT for treatment of CRPS.

Case Report: A 12 year-old girl suffered from CRPS 1 of the ankle after several sprains from sport participation. The patient failed conservative management with pharmacological management and outpatient PT; severe hyperalgesia and generalized pain persisted, resulting in inability to bear weight through the affected limb and diminished quality of life. On admission, popliteal sciatic nerve block was performed with ultrasound-guided catheter placement for continuous infusion of 0.5% ropivicaine and clonidine to facilitate aggressive PT/OT. Infusion rate was titrated to control pain while allowing good motor activity and sensation for four days.

Results: Visual numeric pain scores declined from a 10/10 prior to admission to 2/10 after treatment. Control of ankle and knee musculature resulted in resumption of sport specific activities. Overall ADL performance increased with improved function and quality of life.

Conclusions: Regional block with ropivicaine and clonidine tailored to permit aggressive PT/OT was well tolerated and associated with relief from pain and improved function in this case of CRPS type 1, even at 6 month follow-up. The evolution of ultrasound techniques for nerve block catheter placement now allows this technique to be used with minimal danger of nerve injury. Nerve blocks coordinated with physical medicine approaches may be important in the multi-modal treatment of complex regional pain syndrome.