Endoscopic Thoracic Sympathectomy for Primary Erythromelalgia in the Upper Extremities

Erythromelalgia

“…Special points Mixed results have been reported with sympathectomy [44,45]. Horner's syndrome may occur, especially if the stellate ganglion is removed.…”

“…Lidocaine patch [23] 1 Intravenous lidocaine followed by oral mexiletine [24] 1 Bupivocaine intermittent [25] 1 Lumbar epidural infusion with bupivacaine/fentanyl [26] 1 Cervical epidural infusion with bupivacaine/morphine sulfate and bupivacaine/meperidine [27] 2 Cervical epidural (morphine and bupivacaine) [28] 1 Opioid/opioid agonist Buprenorphine [29] NS Intrathecal hydromorphone and clonidine (α2 agonist) [30] 1 Benzadiazepine (clonazepam) [31] 1 Antihistamines (cyproheptidine) [32] 2 Nonsteroidal anti-inflammatory drugs (piroxicam) [33] 1 Ergot alkaloids Methysergide maleate [34] 1 Methysergide and aspirin [35] 1 Pizotifene [15,36,37] 5 Systemic corticosteroids Prednisone [38] 1 Prednisolone, phenoxybenzamine [39] 1 Growth hormone [40] 1 Magnesium [41] 1 Combination treatment Aspirin, carbamezapine, and propranolol [42] 1 Systemic corticosteroids and pentazocine [43] 1 Sympathectomy and sympathetic nerve blocks Sympathectomy and sympathetic nerve blocks [44,45] 6 Lumbar sympathetic block and total spinal block [46] 1 Lumbar sympathetic ganglion block [47] 1 Lumbar sympathetic blocks [48] 3 Other therapies Hypnotherapy [49] 1 Spinal cord stimulation [50] 1 Neurosurgery…”

A refractory case of secondary erythermalgia successfully treated with lumbar sympathetic ganglion block

“…Low‐dose aspirin usually prevents erythromelalgia from recurring and completely restores the ischaemic acrocyanotic circulation disturbance. 4 Other treatments 15 include methysergide, 16 cryproheptadine 17 (both antiserotonin drugs), gabapentin 18 (anticonvulsant), continuous epidural infusion of bupivacaine and fentanyl 19 and sympathectomy 20,21 for refractory cases ( Table 1). Interestingly, vasodilators such as propranolol 22 and nitroprusside 23 have also been effective in some cases.…”

Erythromelalgia

“…• Mixed results have been reported with sympathectomy [43,44]. Most of the reports demonstrate improvements in symptoms.…”

“…Lidocaine patch [22] 1 Intravenous lidocaine followed by oral mexiletine [23] 1 Bupivacaine intermittent [24] 1 Lumbar epidural infusion with bupivacaine/fentanyl [25] 1 Cervical epidural infusion with bupivacaine/morphine sulfate and bupivacaine/meperidine [26] 2 Cervical epidural (morphine and bupivacaine) [27] 1 Opioid/opioid agonist Buprenorphine [28] NS Intrathecal hydromorphone and clonidine (alpha-2 agonist) [29] 1 Benzadiazepine (clonazepam) [30] 1 Antihistamines (cyproheptidine) [31] 2 Nonsteroidal anti-inflammatory drugs (piroxicam) [32] 1 Ergot alkaloids Methysergide maleate [33] 1 Methysergide and aspirin [34] 1 Pizotifene [14,35,36] 5 Systemic corticosteroids Prednisone [37] 1 Prednisolone, phenoxybenzamine [38] 1 Growth hormone [39] 1 Magnesium [40] 1 Combination treatment Aspirin, carbamazepine, propranolol [41] 1 Systemic corticosteroids and pentazocine [42] 1 Sympathectomy and sympathetic nerve blocks Sympathectomy and sympathetic nerve blocks [43,44] 6 Lumbar sympathetic block and total spinal block [45] 1 Lumbar sympathetic ganglion block [46] 1 Lumbar sympathetic blocks [47] 3 Other therapies Hypnotherapy [48] 1 Spinal cord stimulation [49] 1 Neurosurgery…”