Complex regional pain syndrome induced by extravasation of propofol

Introduction: Complex Regional Pain Syndrome (CRPS) is a chronic disabling painful pathological condition that persists long after the initial injury to the affected limb, triggering characterized by constant pain, allodynia, hyperalgesia, edema, trophic changes, vasomotor dysregulation, and motor deficiency. Usually, the cause is a physical, chemical, or mechanical injury; other times no apparent cause can be identified that could justify the disease. Aspecific continuing pain is the symptomatology, which is not specific and appears disproportionate to any inciting the initial traumatic event. Case presentation: A 36-year-old woman with a history of dysphagia, heartburn, abdominal pain and persistent cough underwent to EGDS with the suspect of a hiatal hernia. During the induction phase of anesthesia by intravenous administration of Propofol, an intravenous anesthetic agent, the extravasation of this drug occurred in the upper right limb tissue. Ten months later further EMG/NCS showed an antalgic reduction of the voluntary recruitment pattern lacking peripheral neuropathy signs. Continuing pain disproportionate to the incidental event, allodynia, temperature asymmetry and alteration of the skin color at the right arm lacking evidence of nerve lesions, confirmed the diagnosis of complex regional pain syndrome type 2. Conclusion: In case of CPRS, the forensic pathologist has to determine the cause in order to prevent a medical malpratice claim, and also it is useful to well known the clinical features to evaluate a state of permanent invalidity. Difficult diagnosis plays a crucial role in the onset of the high disability that the disease causes if it is not recognized on time. The causes of CPRS may be the consequences of a medical error (in the specific case the extravasation of an irritant substance, Propofol) and from subsequent diagnostic delay a very debilitating morbid picture can occurs. For medico-legal purposes, it becomes essential to know the syndrome, and especially to diagnose it in a short time.