Unexpected Lower Limb Pain After Lumbar Sympathectomy in Pediatric CRPS: A Possible Steal Phenomenon?

Abstract

Complex Regional Pain Syndrome (CRPS), a debilitating chronic pain condition, is increasingly recognized in children, often presenting after trauma like sprains, fractures, or even minor injuries. While rarer than in adults, pediatric CRPS predominantly affects adolescent girls, often in the lower extremities. Diagnosis can be challenging, as standard adult criteria may not fully apply. Early diagnosis and multidisciplinary treatment are crucial for restoring function and improving outcomes, which are generally better than in adults. This case report highlights the complexities of pediatric CRPS management, detailing a young child's severe lower limb pain post-otter bite. Despite conservative efforts, a lumbar sympathetic block (LSB) was attempted. Unexpectedly, pain worsened post-block, suggesting a rare "steal phenomenon" complication not well-documented. This case emphasizes the need for pain physicians to be vigilant for unusual CRPS etiologies in children and prepared for unforeseen challenges in their management.