Intravenous regional anesthesia with ketorolac-lidocaine for the management of sympathetically-mediated pain.

This retrospective study was undertaken to determine the usefulness of intravenous regional anesthetic (IVRA) blocks containing ketorolac and lidocaine in the management of sympathetically-mediated pain, and to determine what factors, if any, predicted success with this technique. Sixty-one patients with reflex sympathetic dystrophy presenting to a university-affiliated teaching hospital's pain management center were evaluated. Patients underwent one or more treatments with IVRA blocks containing ketorolac and lidocaine. The duration of pain, site of extremity affected, pain symptomatology, duration of relief from the first IVRA block, absence of pain following a series of IVRA blocks and side-effects from the IVRA blocks were determined. Of the 61 patients, 16 had complete response (26 percent), 26 had a partial response (43 percent) and 19 had no response (31 percent) to the ketorolac-containing IVRA. The only symptom which predicted a failure with this therapy was allodynia. No patient had serious side effects from the IVRA block; dizziness following tourniquet release occurred in 41 percent (n = 25) of the patients. IVRA block containing ketorolac is a useful and minimally invasive technique for the management of patients with reflex sympathetic dystrophy.