Chemical Lumbar Sympathectomy for Ischemic Rest Pain. A Randomized, Prospective Controlled Clinical Trial

Cross, F. W.; Cotton, L. T.

doi:10.1097/00132586-198604000-00022

Cited by 13 publications

(20 citation statements)

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“…The literature search produced 12 articles of which 1 was eliminated secondary to it discussing surgical sympathectomy. The remaining 11 are listed in Table 6 52–62 . A grade of 1C was given to references 51 to 59 as these were low‐quality evidence, but the procedure was strongly recommended for situations where analgesics were ineffective for controlling pain.…”

Section: The Blocksmentioning

confidence: 99%

Sympathetic Blocks: The Evidence

Day

2008

Pain Practice

129

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The sympathetic nervous system has been implicated in numerous pain syndromes ranging from neuropathic pain to vascular pain to visceral pain. In light of this, sympathetic ganglia have been the target of local anesthetic blockade to determine the sympathetic role in the transmission of pain. If analgesia is afforded with local anesthetic blockade, chemical or thermal neurolysis have been utilized to attempt to provide long-term relief. Despite frequent use of minimally invasive sympathetic blocks and neurolysis by pain practitioners, their efficacy for providing analgesia has been sparsely reported in the literature. Many case reports and case series have been published, but few placebo-controlled, blinded studies exist. This manuscript will review the literature on sympathetic blocks and summarize existing studies for each of the sympathetic blocks. The goal is to provide past, current, and future pain physicians with evidence that they can use to provide appropriate care for their patients.

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Section: The Blocksmentioning

confidence: 99%

Sympathetic Blocks: The Evidence

Day

2008

Pain Practice

129

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“…Der pathophysiologische Mechanismus der lumbalen Sympathikolyse beruht auf dem Ausschalten der durch sympathische Fasern bedingten Vasokonstriktion, welche zu einer Verbesserung der Perfusion der Kollateralen und zu einer Senkung des Widerstandes der präkapillären Gefäße führt [9,27]. Im Rahmen der pAVK zählen Verschlüsse der Unterschenkel-und Fußarterien, kombinierte Ober-und Unterschenkelverschlüsse, trophische Ulzera der Unterschenkel und Füße, Nekrosen der Zehen, okklusive Erkrankungen wie die Endangitis obliterans und vasokonstriktive Erkrankungen wie der Morbus Raynaud zu den wichtigsten Indikationen einer Neurolyse am Grenzstrang [6,28,30]. Des Weiteren werden Interventionen mit gutem Therapieerfolg bei Hyperhidrosis [1,30], sympathisch unterhaltenen Schmerzsyndromen wie das chronische regionale Schmerzsyndrom Typ I, Phantom-, Thorax-, Herpes-zosterund Narbenschmerzen sowie der Volkmann'schen Kontraktur durchgeführt [11,28].…”

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“…Ein weiterer Grund für eine beidseitige Sympathikolyse sehen wir in dem unterschiedlichen Wär-meempfinden nach einseitigem Eingriff, welches von den Patienten in der Regel als sehr störend empfunden wird. Insbesondere profitierten Patienten der pAVK-Stadien III und IV[6,8,16], Seibel et al[32] berichten über eine objektivierbare Befundverbesserung mit einer Rückführung des pAVK-Stadiums III nach II bei 85 % der Patienten. Dieses deckt sich sehr gut mit unseren Ergebnissen, wobei sich bei 86 % unserer Patienten eine Beschwerdebesserung mit Herunterstufung des pAVK-Stadiums fand.…”

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Ambulante, CT-gestützte lumbale Sympathikolyse bei Patienten mit schwerer pAVK: Einfluss auf die periphere Perfusion sowie die klinischen Beschwerden

Nickel¹,

Brinckmann²,

Andresen³

2008

Zentralbl Chir

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“…Several authors have described the skin temperature of an extremity as a measure of its blood flow [16,25] when using sympathectomy for treatment of peripheral vascular disease [12,15,25,27], reflex sympathetic dystrophy [12,27], ischemic rest pain [10,27], and sympathetic vasospasm [1,11,26]. But the extent of skin temperature alteration after upper thoracic ganglionectomy and sympathectomy is still unknown.…”

Section: Discussionmentioning

confidence: 99%

Alteration in cardiovascular function and body surface temperature during percutaneous stereotactic upper thoracic ganglionectomy and sympathectomy in palmar hyperhidrotic patients

Chuang

Liu²,

Liu³

2004

Clin Auton Res

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We assessed changes in cardiovascular function, specifically arterial blood pressure and heart rate in 6 palmar hyperhidrotic patients before, during, and after T2 and T3 ganglionectomy and sympathectomy. We also assessed changes in skin temperature, specifically at the forehead, axilla, thumb, loin, and sole of the foot (all bilaterally) in 10 palmar hyperhidrotic patients before, during, and after T2 ganglionectomy and sympathectomy. In both methods, ganglionectomy and sympathectomy were done by percutaneous stereotactic thermocoagulation, under local anesthesia, at room temperature 21.4 +/- 0.6 degrees C. During the procedure we found a significant acute decrease in systolic and pulse pressures, from 153 +/- 10 to 127 +/- 9 and from 80 +/- 7 to 56 +/- 4mmHg respectively, and a lesser decrease in diastolic pressure; heart rate showed no statistically significant changes. We also noted a marked increase in thumb temperature, from 21.2 +/- 0.6 to 36.0 +/- 0.1 degrees C, with a mean increase of 14.8 degrees C, at a room temperature 21.4 +/- 0.6 degrees C, after complete bilateral T2 ganglionectomy and sympathectomy. Skin temperature at the forehead, axilla, loin, and sole of the foot, all measured bilaterally, showed no significant increase, although there was a decrease in sweating in both forehead and axillary regions. The decrease in systolic and pulse pressures observed during the thermocoagulation procedure were temporary effects. The increase in thumb temperature, however, appears to be a permanent effect for palmar hyperhidrotic patients. Finally, the data indicate that the sympathetic innervation of the blood vessel in the periphery presents a segmental organization.

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Chemical Lumbar Sympathectomy for Ischemic Rest Pain. A Randomized, Prospective Controlled Clinical Trial

Cited by 13 publications

References 0 publications

Sympathetic Blocks: The Evidence

Sympathetic Blocks: The Evidence

Ambulante, CT-gestützte lumbale Sympathikolyse bei Patienten mit schwerer pAVK: Einfluss auf die periphere Perfusion sowie die klinischen Beschwerden

Alteration in cardiovascular function and body surface temperature during percutaneous stereotactic upper thoracic ganglionectomy and sympathectomy in palmar hyperhidrotic patients

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