[Cervical epidural infusion of morphine and bupivacaine in severe erythromelalgia]

A 13 year old boy was admitted suffering from severe burning pain in both hands and distal forearms of two months duration. The skin in the affected areas was red and warm and was cooled by the boy with ice for alleviation of pain. Laboratory tests revealed no abnormalities. The diagnosis of primary erythromelalgia was made on the basis of the history and physical examination. At the age of nine months the boy had undergone surgery for hexadactyly of the right hand. In addition, the boy had complained of transient burning sensations in both feet several months prior to admission. Revision of the old scar at the beginning of the hand symptoms had been without effect. Initial analgesic attempts with oral paracetamol, acetylsalicylic acid, tramadol and intravenous morphine also had had no effect. Carbamazepine, methysergide and immunoglobulins led to no improvement. Symptomatic relief was achieved only by cooling the distal parts of both arms with water. This caused oedema and maceration of the skin after several days. The placement of a cervical epidural catheter and the infusion of morphine and bupivacaine led to a pronounced pain relief within hours and the forearms could be removed from the cool water. The epidural infusion was continued for two weeks with slowly decreasing amounts of morphine and bupivacaine. During this time there was a marked improvement in both oedema and erythema. No complications resulted from the cervical epidural infusion. Because of the long-standing immobilisation and water exposure the boy had to undergo intensive training of the upper extremities during the following weeks to regain full muscular function.(ABSTRACT TRUNCATED AT 250 WORDS)