Management of Lower Limb Complex Regional Pain Syndrome Type 1: An Evaluation of Percutaneous Radiofrequency Thermal Lumbar Sympathectomy Versus Phenol Lumbar Sympathetic Neurolysis—A Pilot Study

Manjunath, Prashanth S; Jayalakshmi, T; Dureja, G. P.; Prevost, A. Toby

doi:10.1213/01.ane.0000298285.39480.28

Cited by 75 publications

(48 citation statements)

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“…[1] In a pilot study, percutaneous radiofrequency thermal lumbar sympathectomy has been compared to phenol lumbar sympathetic neurolysis for the treatment of complex regional pain syndrome type 1. [3] In that study, authors have found that both treatment modalities are safe and effective procedures for providing satisfactory pain relief.…”

Section: Introductionmentioning

confidence: 96%

Radiofrequency termocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes

Destegül¹,

Işik²,

Özbek³

et al. 2017

Agri

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SummaryObjectives: Radiofrequency thermocoagulation (RFT) has been reported to be used safely to treat ischemic lower extremity pain. The objective of the present study was to evaluate efficiency of RFT for treatment of lower extremity ischemic pain and to compare effectiveness of monopolar RFT and bipolar RFT modes. Methods: Following ethics committee approval, 30 American Society of Anesthesiologists classification I-III patients with ischemic lower extremity pain aged between 18 and 65 years were recruited. Patients were randomly allocated into 2 groups: MRT group (n=15) received monopolar RFT (80°C) for 2 minutes at L2-3 level, and BRT group (n=15) received bipolar RFT (80°C) for 2 minutes at L2-3 level. Systolic and diastolic blood pressure, heart rate, pain score, and supplemental analgesic requirements were recorded at 24 hours after application and at 7, 30, and 90 days. Results: Numerical rating scale values in both groups decreased significantly over time and it was found to be significantly lower in BRT group after first and third months (p<0.05). Supplemental analgesic requirements were similar with no significant difference between the 2 groups at any point of study period (p>0.05). No adverse event or complication related to procedure or treatment was reported. Conclusion: In patients with ischemic lower extremity pain, both monopolar and bipolar RFT treatment modalities were found to significantly decrease pain levels. However, bipolar mode led to lower pain scores at 30 and 90 days, and longer duration of analgesia than monopolar mode.Keywords: Radiofrequency thermocoagulation; monopolar; bipolar; ischemic pain; lumbar sympatholysis. ÖzetAmaç: Alt ekstremitenin iskemik ağrı tedavisi için radyofrekans termokoagülasyon'un (RFT) güvenle kullanılabileceği bildirilmiştir. Bu çalışmanın amacı alt ekstremitenin iskemik ağrı tedavisi için RFT'un etkinliğini değerlendirmek ve monopolar ve bipolar RFT modlarını karşılaştırmaktı. Gereç ve Yöntem: Etik komite kabulünü takiben alt ekstremite iskemik ağrısı olan, yaşları 18-65 yaş arası, ASA I-III grubu, 30 hasta çalışmaya alındı. Hastalar MRT grubunda (n=15) L 2-3 düzeyinden 2 dakika monopolar RFT (80°C), BRT grubunda (n=15) ise L 2-3 düzeyinden 2 dakika bipolar RFT (80°C) almak üzere rastgele iki gruba ayrıldı. Sistolik ve diastolik kan basınçları, kalp atım hızı, ağrı skorları (NRS) ve ek analjezik ihtiyaçları hastaneden taburcu edildikten 24 saat ve 7, 30 ve 90. günlerde kaydedildi. Bulgular: Her iki grupta NRS skorlarının zaman içerisinde önemli derecede azaldığı ve BRT grubunda MRT grubuna göre 30 ve 90. günlerde istatistiksel olarak önemli derecede daha düşük olduğu tespit edildi (p<0.05). Bununla birlikte, ek analjezik ihtiyacının iki grupta benzer olduğu ve iki grup arasında çalışma periyodlarında istatistiksel fark oluşturmadığı tespit edildi (p>0.05). İşlem veya tedaviye ilişkin yan etki veya komplikasyon bildirilmedi. Sonuç: Alt ekstremitenin iskemik ağrı tedavisinde hem monopolar hem de bipolar radyofrekans termokoagülasyon tedavi modalitelerinin ...

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Section: Introductionmentioning

confidence: 96%

Radiofrequency termocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes

Destegül¹,

Işik²,

Özbek³

et al. 2017

Agri

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“…In patients responsive to sympathetic blocks, RFA or phenol neurolysis may provide longer-term symptom control (16,17). RFA may be preferred to phenol based on reports of neuropathic pain symptoms secondary to phenol neurolysis (18). If patients fail to obtain adequate symptom control with the aforementioned treatment, spinal cord/peripheral nerve stimulation or an implantable drug delivery system may be considered (19-21).…”

Section: Case Reportmentioning

confidence: 99%

Management of Complex Regional Pain Syndrome

Cavazos

Burnett

2017

Baylor University Medical Center Proceedings

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“…El efecto placebo en pacientes agradecidos y las grandes dosis de anestésico local que provocan una inhibición central de la nocicepción pueden dificultar la interpretación del bloqueo simpático diagnós-tico (30,31).…”

Section: Signos De Eficacia Del Bloqueounclassified

Bloqueo simpático lumbar

Mesa

Granados

Hoyos

et al. 2013

Rev. Soc. Esp. Dolor

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simpático lumbar. Rev Soc Esp Dolor 2013; 20(6): 324-331. INTRODUCCIÓNEn 1924 Brunn y Mandl describieron por primera vez el bloqueo percutáneo de la cadena y simpática lumbar, inspirados en el abordaje del plexo celiaco descrito por Kappis. Con esta técnica se pretendía obtener un bloqueo simpá-tico efectivo pronóstico o terapéutico menos agresivo que la simpatectomía estándar desarrollada por Adson y Díez a principios del siglo XX (1). Pronto variantes como las descritas por Bryce Smith (1951) y Wallace (1957) hacían el procedimiento más tolerable incorporando la utilización de anestésicos locales y evitando el contacto con las apó-fisis transversas. En 1970 Reid describe el abordaje lateral considerado actualmente como técnica estándar.Desde la segunda mitad del siglo pasado el bloqueo simpático lumbar fue implementado fundamentalmente por anestesiólogos en las unidades de dolor. En 1950 Bonica, Moore y Arnulf describieron la importancia del bloqueo simpático lumbar en el tratamiento de la causalgia y distrofia simpática refleja postraumática en excombatientes de la Segunda Guerra Mundial.Con el desarrollo tecnológico se han incorporado técni-cas de imagen que aportan eficacia y seguridad a la técni-ca original. En 1947 Duncan Alexander inyectó contraste iodado al realizar una simpatectomía química lumbar para evidenciar la difusión del agente neurolítico, pero no es hasta 1976 cuando Robert Boas introduce como práctica clínica habitual la monitorización fluoroscópica continua de inyecciones de contraste iodado y alcohol en el abordaje de la cadena simpática lumbar.En 1990, Reddy y Chitangada usaron por primera vez el TAC en el bloqueo simpático lumbar (2) logrando resultados satisfactorios (3,4).Una nueva alternativa a la neurólisis clásica aparece con la introducción de la radiofrecuencia. En 1991 Haynswoorth y Noe utilizaron por primera vez la radiofrecuencia como alternativa a la neurólisis química obteniendo un menor índice de complicaciones.Recientemente la incorporación los bloqueos ecoguiados ha planteado un nuevo reto. En 1992 Kirvelä demuestran la posibilidad de realizar el procedimiento bajo control ecográfico aunque la dificultad técnica es notable y debe complementarse con control fluoroscópico (5,6). SISTEMA NERVIOSO AUTÓNOMO SIMPÁTICOEl sistema nervioso simpático está implicado en la géne-sis y perpetuación del dolor neuropático, vascular y visceral. El bloqueo de los ganglios simpáticos lumbares constituye una fuente básica de información que nos proporciona una idea certera sobre el papel del sistema autónomo en un síndrome doloroso concreto.El sistema nervioso simpático o toracolumbar tiene su origen en la médula espinal, entre los segmentos C8 o T1. Podemos distinguir un brazo eferente que aporta flujo simpático a nervios metaméricos y esplácnicos y un brazo aferente que vehicula la sensibilidad visceral. El brazo eferente de la vía simpática se compone de dos neuronas, una preganglionar y una posganglionar (7).

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Management of Lower Limb Complex Regional Pain Syndrome Type 1: An Evaluation of Percutaneous Radiofrequency Thermal Lumbar Sympathectomy Versus Phenol Lumbar Sympathetic Neurolysis—A Pilot Study

Abstract: Based on this pilot study, radiofrequency lumbar sympathectomy may be comparable to phenol lumbar sympathectomy. A larger trial is required to confirm these findings.

Cited by 75 publications

References 9 publications

Radiofrequency termocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes

Radiofrequency termocoagulation for the treatment of lower extremity ischemic pain: Comparison of monopolar and bipolar modes

Management of Complex Regional Pain Syndrome

Bloqueo simpático lumbar

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