Dispersal of radioisotope labelled solution following deep dermal injection in Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) is the commonest inherited disorder of connect ive tissue, affecting around 10000 patients in the UK. Patients with EDS ha ve reported that local anaesthetic is often ineffective. Patients with less severe skill laxity often have the most problems. We have postulated that this resistance to local anaesthetics is not due to the lax connective tiss ues as is often assumed. This study used radioactively labelled solution (Tc-99m-pertechnetate) admi nistered as a deep dermal injection in the forearm. The rate of dispel-sal of isotope was measured over GO min and found to be identical between six p atients with EDS and three controls. The effects of local anaesthetics are complex and depend on the individual chemical properties of the agent and a number of tissue factors. This study would suggest that the lack of effectiveness of local anaesthetic solution s is not due to rapid dispersal of solution. It is unlikely therefore that its lack of effect can be compensated for by simply increasing the amount u sed. The diagnosis of EDS should be considered in any patient who complains unexpectedly of pain during their procedure, particularly when the surgeon knows that an adequate volume of local anaesthetic has been used. (C) 2000 The British Association of Plastic Surgeons.