Complex Regional Pain Syndrome (CRPS) is an uncommon and potentially debilitating neuropathic pain condition that may develop after surgical or iatrogenic nerve injury. Although CRPS predominantly affects the extremities, pelvic and perineal involvement is rare and poorly characterized. We report the case of a 54-year-old woman who developed CRPS following CO₂ laser labioplasty performed as part of a combined gynecologic surgical procedure. The patient presented with progressive neuropathic pain, allodynia, vasomotor and trophic skin changes, and motor impairment predominantly affecting the perineal region and right lower limb. Structural pathology was excluded by imaging. The diagnosis of CRPS was established using the Budapest Criteria. Initial pharmacologic therapy and a selective pudendal nerve block provided limited and transient relief. A multimodal interventional strategy combining repeated caudal epidural blocks, intravenous lidocaine and magnesium sulfate, and epidural preservative-free ketamine resulted in complete pain resolution, reversal of trophic changes, and full functional recovery. This case highlights CRPS as a potential complication of CO₂ laser labioplasty and supports early, mechanism-based multimodal interventional management in refractory cases, particularly when central sensitization is suspected.
Veraza et al. (Wed,) studied this question.