gms | German Medical Science

132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

Remote Ischemic Conditioning causes a decrease of blood flow in patients with CRPS

Meeting Abstract

  • Tobias Sebastian Hegelmaier - Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Abteilung für Schmerzmedizin, Bochum, Deutschland
  • Christoph Maier - Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Abteilung für Schmerzmedizin, Bochum, Deutschland
  • Marcus Lehnhardt - Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Abteilung für Schmerzmedizin, Bochum, Deutschland
  • Jonas Kolbenschlag - Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Abteilung für Schmerzmedizin, Bochum, Deutschland
  • Nina Kumowski - Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Abteilung für Schmerzmedizin, Bochum, Deutschland
  • Tina Mainka - Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Abteilung für Schmerzmedizin, Bochum, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch012

doi: 10.3205/15dgch012, urn:nbn:de:0183-15dgch0122

Published: April 24, 2015

© 2015 Hegelmaier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Introduction: Despite of a lot effort in the investigation of the Complex Regional Pain Syndrome (CRPS), many aspects of its pathophysiology are still unknown. CRPS typically presents with vaso- and sudomotor symptoms and signs such as skin temperature side differences. Previous studies also showed differences in perfusion of affected and non-affected limbs.

Remote Ischemic Conditioning (RIC) is a systemic phenomenon. Even though RIC gained more access into clinical practice in the past years, especially in the field of reconstructive surgery, the exact physiology of this mechanism is still unknown. Two different mechanisms are currently under discussion: On the one hand RIC might be caused by NO release, on the other hand it could be caused by a reaction of the autonomic nerve system. Within this study changes of the microcirculation in patients with unilateral CRPS of the upper limb during RIC were going to be analyzed in comparison to healthy controls and patients with other unilateral neuropathic pain states of the upper limb.

Material and methods: Microcirculatory data of 15 patients with unilateral CRPS of the upper limb (11 females, 53 ± 13 years), 8 age- and sex-matched healthy controls (7 females, 55 ± 15,5 years) and 6 patients with other unilateral neuropathic pain syndromes of the upper limb (5 females, 43,5 ± 13) were recorded continuously in the affected or dominant hand using combined Laser-Doppler and photospectrometry (Oxygen-to-see, Lea Medizintechnik, Germany). Probes were attached to the distal palmar middle finger (superficial probe) and to the thenar (deep probe). 10 minutes of baseline measurement were followed by 3 alternating cycles of 5 minutes ischemia using a tourniquet on the contralateral upper arm and 10 minutes of reperfusion. Linear regression was used to calculate the blood flow in each phase (baseline, ischemia, perfusion). For each subject, the change of blood flow between baseline and 10-minutes reperfusion during the 3rd cycle was calculated for the superficial and deep probe. These end-points were compared between groups using the Mann-Whitney-U-test.

Results: In contrast to healthy subjects and to patients with other unilateral neuropathic pain syndromes, the superficial and deep blood flow in patients with CRPS was decreased in the 3rd reperfusion phase compared to baseline (each p<0,01). The decrease of perfusion was higher in patients with CRPS compared to controls (superficial: p=0,131, deep: p<0,05) and to patients with other unilateral neuropathic pain syndromes (superficial: p<0,05, deep: p=0,066). Patients with other unilateral pain syndromes showed the same decrease of blood flow as healthy subjects (superficial: p=0,059, deep: p=0,950). Accentuation of the results is expected after recruitment of the calculated sample size.

Conclusion: In patients with CRPS, RIC leads to a significant decrease of the superficial and deep blood flow compared to healthy subjects and to patients with other painful neuropathies. An explanation for this effect could be a higher uptake rate of NO in patients with CRPS, which would lead to lower reserves for a NO-mediated reaction during RIC. Also a dysfunction of the autonomic nerve system could cause a decrease of blood flow in patients with CRPS. Further investigations are needed to show whether a correlation between blood flow and function of the autonomic nerve system, which is also impaired in a subgroup of CRPS-patients, exists.