Is there neural and functional recovery after clip removal in cervical experimental sympathectomy? / Existe recuperação neural e funcional após a retirada de clipe quando da indução de simpatectomia cervical experimental?

ABSTRACT Background: The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon. Aim: To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal. Method: In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen. Results: The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2. Conclusions: The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.

RESUMO Racional: O tratamento cirúrgico da hiperidrose pela simpatectomia torácica trouxe além do alívio sintomático para muitos, também seu principal efeito adverso: o suor compensatório ou reflexo. A técnica de clipagem do nervo simpático no lugar de sua secção deu margem à esperança de reversão do procedimento; porém, os resultados mostram-se bastante divergentes e pouco conclusivos Objetivo: Observar a lesão provocada pelo clipe de polímero em nervo simpático de coelhos sete dias após sua clipagem, comparando-a com os achados após três semanas da retirada do clipe. Método: Estudo experimental, com amostra formada por 20 coelhos, divididos em dois grupos de 10, sendo o grupo 1 chamado clipagem e o 2, desclipagem. Todos foram submetidos à clipagem do nervo simpático cervical direito com clipe polimérico, e no grupo 2 realizou-se a desclipagem sete dias após. Os coelhos do grupo 1 foram submetidos à eutanásia no 7º dia de pós-operatório, e os do grupo 2 no 21º dia após a remoção do clipe. Observou-se na macroscopia o aspecto do clipe, a presença de lesão de descontinuidade, infecção e aderências ao redor do nervo. Para estudo microscópico utilizou-se a coloração H&E na avaliação das fases, grau do processo inflamatório e presença de necrose, e a de picrosirius red F3BA para quantificação de colágeno. Resultados: O nervo simpático cervical foi identificado íntegro, sem necrose ou infecção em todos os animais do experimento; havia aderências em ambos os grupos, sendo mínimas em oito de cada grupo e moderadas ou intensas em dois; em toda a amostra o clipe encontrava-se completamente fechado no 7º dia de pós-operatório; o processo inflamatório presente foi do tipo crônico, com predomínio monomorfonuclear, não se observando diferença significativa em relação ao grau do processo inflamatório entre os grupos; porém, a quantidade de colágeno tanto do tipo I quanto do tipo III foi significativamente maior no grupo 2. Conclusões: A lesão provocada pelo clipe de polímero em nervo simpático pode ser reversível possibilitando o retorno funcional nas áreas envolvidas na simpatectomia cervical simulada. A clipagem do nervo simpático cervical com uso de clipe de polímero não causa lesão de descontinuidade.

A Report on Bilaterally Elongated Superior Cervical Ganglion

Superior cervical ganglion (SCG), the largest of the three cervical sympathetic ganglia, is formed by the fusion of first four cervical ganglia. Bilaterally elongated superior cervical ganglion was observed in a female cadaver during dissection. On the right side, it was 63.74 mm long and 5.75 mm wide and on the left side, it was 62.88 mm and 5.84 mm respectively. Histological analysis of the ganglion done with toluidine blue staining confirmed the structure of sympathetic ganglion. Superior cervical ganglion is the preferred ganglion for sympathetic block in conditions like trigeminal neuralgia, atypical facial pain,and post-herpetic neuralgia. Even though superior cervical ganglion has been reported to be at the safest location, thetension of sympathetic trunk while retracting the carotid sheath during surgeries might result in Horner’s syndrome. Furthermore, a large ganglion may also be confused with deep cervical lymph nodes or retropharyngeal mass during imaging studies. Understanding the variant anatomy of the superior cervical ganglion might serve as a guide for imaging studies, cervical spine surgeries,and sympathetic block.

A Synergistic Effect Between Kampo Medicine and Cervical Sympathetic Block / 日本東洋医学雑誌

We experienced a patient whose left back pain disappeared after treatment combined with Kampo medicine and cervical sympathetic block. A 74-year-old woman developed pain without trigger over one year. The patient received Kampo medicine classified for treating kankiukketsu and cervical sympathetic block. Three months later, the patient was relieved from the prolonged pain. It was suggested that the synergistic effect between Kampo medicine and cervical sympathetic block could relieve prolonged pain more rapidly by bringing more effective relief of autonomic dystonia.

A brief report on a technical description of ultrasound-guided lumbar sympathetic block

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.

Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail.

Raquianestesia total após bloqueio de gânglio estrelado em paciente com síndrome dolorosa complexa regional: relato de caso / Total spinal anesthesia after stellate ganglion block in complex regional painful syndrome patient: case report

JUSTIFICATIVA E OBJETIVOS: A síndrome dolorosa complexa regional (SDCR) é uma síndrome dolorosa debilitante, com prevalência elevada em serviços de tratamento de dor. Apresenta diversas opções terapêuticas, sendo o bloqueio regional simpático uma das mais efetivas. O objetivo deste estudo foi relatar a intercorrência incomum do bloqueio de gânglio estrelado em paciente portadora de SDCR no membro superior direito. RELATO DO CASO: Paciente do sexo feminino, 49 anos, estado físico ASA I, admitida para tratamento de dor no ombro superior direito de forte intensidade, em queimação, associada a mudanças tróficas, após oito meses de traumatismo local. Diagnosticada com SDCR, indicou-se bloqueio simpático em gânglio estrelado. Após monitorização realizou-se bloqueio com bupivacaína a 0,5% (8 mL), evoluindo, após injeção em topografia de gânglio estrelado por abordagem paratraqueal, com parestesia de membros distal, ansiedade e taquidispneia importante. Imediatamente a paciente foi sedada e realizada intubação orotraqueal, permanecendo em observação por 135 minutos. Recuperada, foi levada para a sala de recuperação pós-anestésica (SRPA). Após três dias do procedimento, relatou redução de dor na escala visual analógica, de 10 para 3 pontos. CONCLUSÃO: Bloqueios regionais já demonstraram eficácia elevada no tratamento de quadros dolorosos vários, incluindo a SDCR. Este caso demonstrou que, apesar de serem incomuns, efeitos indesejáveis podem ocorrer, e o anestesiologista deve estar preparado para o suporte adequado do paciente nessas situações. O conhecimento adequado da anatomia e da técnica anestésica reduz a ocorrência desses efeitos.

BACKGROUND AND OBJECTIVES: Complex regional painful syndrome (CRPS) is a debilitating painful syndrome, with high prevalence in pain management centers. CRPS has several therapeutic options being regional sympathetic block one of the most effective. This study aimed at reporting an uncommon intercurrence of stellate ganglion block in patient with right upper limb CRPS. CASE REPORT: Female patient, 49 years old, physical status ASA I, admitted for management of severe right shoulder burning pain, associated to trophic changes eight months after local trauma. Diagnosis was CRPS and sympathetic stellate ganglion block was indicated. After monitoring, blockade was induced with 0.5% (8 mL) bupivacaine, evolving, after injection in stellate ganglion topography by paratracheal route, with distal limbs paresthesia, anxiety and severe tachydyspnea. Patient was immediately sedated and intubated, remaining in observation for 135 minutes, being then transferred to the post-anesthetic recovery unit (PACU). Three day after procedure, patient reported pain decrease from 10 to 3 according to the visual analog scale. CONCLUSION: Regional blocks are highly effective to manage different pain conditions, including CRPS. This case has shown that, although being uncommon, there might be undesirable effects and the anesthesiologist has to be prepared to adequately support patients in such situations. Adequate understanding of anatomy and of the anesthetic technique decreases the incidence of such effects.

Bloqueio do sistema nervoso simpático para tratamento de dor do membro fantasma: relato de caso / Sympathetic nervous system block to control phantom limb pain: case report

JUSTIFICATIVA E OBJETIVOS: A sensação do membro fantasma é um fenômeno que acomete pacientes submetidos à amputação de qualquer um dos membros, e essa sensação pode ser acompanhada ou não de dor. Este relato teve por objetivo apresentar um caso no qual o bloqueio do sistema nervoso simpático foi utilizado como adjuvante no tratamento da dor do membro fantasma. RELATO DO CASO: Paciente portador de carcinoma epidermoide de punho que evoluiu com dor do membro fantasma após amputação do antebraço esquerdo. Foi submetido a tratamento conservador e de reabilitação física, porém a analgesia obtida com terapia farmacológica foi insuficiente e o paciente evoluiu com dor do coto de amputação e dor mediada pelo sistema nervoso simpático. Finalmente, o paciente foi submetido a bloqueio simpático venoso seguido de bloqueio diagnóstico da cadeia simpática torácica com redução significativa da dor. CONCLUSÃO: Nesse caso foi utilizado o bloqueio do sistema nervoso simpático por meio de infusão venosa de lidocaína, seguido de bloqueio da cadeia simpática torácica como opção terapêutica para dor do membro fantasma. Nessa sequência, foi obtido alívio da dor, sem surgimento de efeitos adversos.

BACKGROUND AND OBJECTIVES: Phantom limb sensation is a phenomenon affecting patients submitted to amputation of any limb and this sensation may or may not be followed by pain. This report aimed at presenting a case where sympathetic nervous system block was used as adjuvant to control phantom limb pain. CASE REPORT: Patient with wrist epidermoid carcinoma, who evolved with phantom limb pain after left forearm amputation. Patient was submitted to conservative treatment and physical rehabilitation, however drug therapy analgesia was insufficient and patient evolved with pain in the amputation stump and sympathetic nervous system-mediated pain. Ultimately, patient was submitted to sympathetic venous block followed by diagnostic chest sympathetic chain block with significant pain decrease. CONCLUSION: Sympathetic nervous system block in this case was induced with venous lidocaine infusion, followed by chest sympathetic chain block as therapeutic option for phantom limb pain. This sequence has provided pain relief without adverse effects.

Sympathetic Block for Treating Primary Erythromelalgia

Primary erythromelalgia is a rare condition that's characterized by erythema, an increased skin temperature and burning pain in the extremities. The pain is often very severe, and treating erythromelalgia is frustrating and difficult. We report here on the case of a 12-year old girl with primary erythromelalgia in both lower extremities. The pain was refractory to medical treatment, but a bilateral sympathetic block with lidocaine and triamcinolone resulted in relief from the pain. Our experience with this disease demonstrates that sympathetic blocks are effective in improving the symptoms and they may be attempted on erythromelalgia patients who do not respond to other treatments, including medication and epidural blocks.

Aplicación del bloqueo del ganglio estrellado en el tratamiento de dos pacientes con angina refractaria crónica

RESUMEN Objetivo. Evaluación y seguimiento de dos pacientes a los que se les realizó la técnica de Bloqueo del Ganglio Estrellado (BGE) como tratamiento del ángor refractario. Casos clínicos. Se controla durante un período de 12 meses la evolución de dos pacientes con angina crónica refractaria a los que se les realizó la técnica de BGE por abordaje anterior izquierdo bajo fluoroscopía. Durante el control evolutivo se registraron la aparición de episodios anginosos y su relación con la actividad diaria, así como el incremento en el uso de medicación antiisquémica. En ambos casos se logró remisión de la sintomatología sin constatarse complicaciones, permaneciendo libres de síntomas entre dos y tres meses, reiterándose el procedimiento ante la aparición de dolor precordial al esfuerzo. Conclusión. La simpatectomía temporal aparece como una opción efectiva, bien tolerada y de bajo riesgo en pacientes ambulatorios con angina refractaria a tratamiento médico y revascularización, aplicada en el marco de un tratamiento de Cuidado Integral Cardiovascular.

summary Objective. Evaluation and follow-up of two patients whom Stellate Ganglion Blockade (SGB) Technique was performed to treat chronic refractory angina. Clinical cases. We analyzed during a year period two patients with refractory angina despite optimal medication who underwent repeated Stellate Ganglion Block under fluoroscopic guidance by left anterior approach. We recorded the presence or absence of chest pain and the number of anti-angina medications pre and post-treatment. Both patients achieve pain relief without complications. The period of complete pain relief was two and three months for each patient. SGB was repeated when angina returned. Conclusions. Temporal sympathectomy may provide a safe and effective option in patients with angina pectoris that is refractory to optimal medication and revascularization as part of holistic care. Continuous fluoroscopy monitoring may also prevent serious complications.

resumo Objetivo. Avaliação e seguimento de dois pacientes nos quais realizou-se a técnica do Bloqueio do Gânglio Estrelado (BGE) como tratamento da dor anginosa refratária. Casos Clínicos. Controla-se durante um período de 12 meses a evolução de dois pacientes com angina crônica refratária nos quais realizou-se a técnica de BGE por abordagem anterior esquerda sob fluoroscopia. Durante o controle evolutivo registrou-se o aparecimento de episódios anginosos e sua relação com a atividade diária assim como o incremento no uso de medicação anti-isquêmica. Em ambos casos logrou-se remissão da sintomato-logia sem que se constatasse complicações, permanecendo livres de sintomas por 2 a 3 meses, reiterando-se o procedimento ante a aparição de dor pré-cordial ao esforço. Conclusão. A simpatectomia temporal surge como uma opção efetiva, bem tolerada e de baixo risco em pacientes ambulatoriais com angina refratária a tratamento médico e revascularizacão, aplicada no conjunto de um tratamento cardiovascular integral.

Lumbar Sympathetic Block for Spinal Cord Infarction Patient: A case report / 대한통증학회지

This report describes a case of spinal cord infarction after acupuncture. The patient was treated with lumbar sympathetic block with using C-arm fluoroscopy. A 66-year-old patient with chronic low back pain and radiating pain in the lower limb was treated with acupuncture and he suddenly had a loss of motor and sensory of both lower extremities. His clinical presentaion and neuroimaging studies were consistent with spinal cord infarction. He was treated with steroid megatherapy and he showed improved in motor function, but there was no pain relief despite the phamacological treatments that were combined with caudal blockade. He visited to our hospital and had lumbar sympathetic blockade performed. The pain was relieved without any related complication after 1 month (VAS 9/10 --> 2/10), and he has been content with the results of treatment.

The Effect of Lumbar Sympathetic Block in Interstitial Cystitis: A case report / 대한통증학회지

Interstitial cystitis is an extremely painful and distressing condition, characterized by severe suprapubic pain, which increases with bladder filling and is relieved by voiding. The daily frequency of micturition may approach 100 times, but no incontinence is observed. The symptoms persist throughout the night, which consequently affects sleep. The etiology of this condition is still unknown, but includes infection, autoimmune response, allergic reaction, neurogenic inflammation, epithelial dysfunction and inherited susceptibility. Herein, a case of interstitial cystitis, with severe symptoms, which was successfully treated with lumbar sympathetic block, is reported.

Severe Compensatory Hyperhidrosis after a Lumbar Sympathetic Ganglion Block: A case report / 대한마취과학회지

A healthy, 25-year old female patient with no medical history complained of excessive palmar, plantar, axillary, back, and thigh sweating due to stress or a high temperature. Her whole body hyperhidrosis was often disabling and embarrassing in daily life. Plantar hyperhidrosis interfered with her social activities, and accordingly, she was suggested to have a lumbar sympathetic ganglion block with alcohol. Right side ganglion block was performed without any problem at the 3rd and 4th lumbar vertebrae. After sympathetic block, right foot sweating stopped, but phantom sweating continued for a week, and an ache in the pelvic area and flushing of the right foot continued for more than 10 days. Thus a left side procedure was postponed, but all symptoms disappeared after 21 days and the chemical neurolytic block of left side was subsequently performed, and plantar hyperhidrosis was resolved. However, 2 days after completing the lumbar sympathetic block, excessive sweating occurred in the facial, axillary, and back regions with upper body flushing. Two months later, her whole body, excepting the lower extremity showed running sweat after a 10 minute walk on exertion. To reduce the sweating, aluminum chloride, and oral and topical glycopyrrolate were prescribed to no affects. She is currently waiting for the return of normal lumbar sympathetic ganglion function.

Minimal Concentration of Lidocaine for a Diagnostic Stellate Ganglion Block / 대한마취과학회지

BACKGROUND: The aim of this study was to determine an adequate minimal concentration of lidocaine in a stellate ganglion block for decreasing a false positive response to a diagnostic sympathetic blockade determining whether the patient's pain is SMP or SIP. METHODS: This crossover study was performed in twenty patients with sudden sensory neural hearing loss. All patients received three times SGB using three different concentrations (1%, 0.5% and 0.25%) of 8 ml lidocaine at the sixth cervical vertebral level via an anterior paratracheal approach. The blocks were separately done at one week intervals in random order. The occurrence, onset time and action duration of Horner's syndrome were observed after each SGB. RESULTS: Positive cranial sympathetic blockade (Horner' syndrome) was present in all patients using 1% and 0.5% lidocaine. It was present in 60% of the patients using 0.25% lidocaine. Onset time was not significantly different among the three groups. Action duration of 1% and 0.5% lidocaine groups was significantly longer than the 0.25% lidocaine group. There was no critical side effects, and temporary foreign body sensation was the most common side effect. CONCLUSIONS: The results of this study suggest that 0.5% lidocaine is an adequate minimal concentration for diagnostic SGB. Therefore, we recommend that 0.5% lidocaine instead 1% should be used in diagnostic SGB to decrease a false positive response to a sympathetic blockade.

Chemical Lumbar Sympathetic Block: Comparison of One- Versus Two-needle Techniques / 대한마취과학회지

BACKGROUND: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. METHODS: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and third lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. RESULTS: The duration of anhidrosis was 12.2 2.6 months (mean SD) in the single-needle group versus 13.6 3.6 months (mean SD) in the two-needle group. CONCLUSIONS: As these results were not significantly different from those obtained in patients having a two-needle sympathectomy, blockade of the single-needle technique under C-arm fluoroscopy is considered to be effective for a neurolytic lumbar sympathectomy.

Chemical Lumbar Sympathetic Block: Comparison of One- Versus Two-needle Techniques / 대한마취과학회지

BACKGROUND: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. METHODS: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and third lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. RESULTS: The duration of anhidrosis was 12.2 2.6 months (mean SD) in the single-needle group versus 13.6 3.6 months (mean SD) in the two-needle group. CONCLUSIONS: As these results were not significantly different from those obtained in patients having a two-needle sympathectomy, blockade of the single-needle technique under C-arm fluoroscopy is considered to be effective for a neurolytic lumbar sympathectomy.

Neural Blockade

The sympathetic nervous system has been implicated in the maintenance of numerous pain syndromes. Interruption of sympathetic pathways has been widely applied to relieve pain. Neurolytic sympathetic block is often well tolerated, because numbness and motor weakness are uncommon and neuritis rarely develops. The classic targets for sympatholysis are the stellate or cervicothoracic ganglion for facial and upper extremity pain, celiac plexus for abdominal pin, and lumbar sympathetic chain for lower extremity pain. In addition, the thoracic ganglion is occasionally blocked for the treatment of hyperhidrosis and of pain emanating from the pleura and esophagus. The recognition of the clinical utility of cervical epidural nerve block in the management of head, face, neck, shoulder, and upper extremity pain has brought the technique into the mainstream of contemporary pain management practice. Lumbar epidural nerve block has great utility in the management of a variety of acute, chronic, and cancer-related pain syndromes. The nerve root sleeve is particularly accessible to precise local anesthetic blocks. Segmental information gained from such nerve root blocks can be helpful in sorting out confusing patterns of referred pain to the limbs. The pathway for insertion of spinal needles must be planned so as to avoid damaging neural structures. Spinal nerve roots are particularly delicate structures and do not take kindly to being impaled.

How Long Should a Patient Stay in Lateral Position for Unilateral Spinal Anesthesia with Hyperbaric Bupivacaine? / 대한마취과학회지

BACKGROUND: In searching for a differential spinal block between dependent and nondependent sides, we evaluated the influence of the duration of lateral decubitus on the spread of hyperbaric bupivacaine during spinal anesthesia. METHODS: Spinal anesthesia with 1.2 ml of hyperbaric 0.5% bupivacaine (6 mg) was administered with a 25-gauge Whitacre unidirectional needle to 50 ASA 1 patients undergoing unilateral knee arthroscopy. The patients were allocated randomly to three groups according to the duration of lateral decubitus after spinal injection in the lateral position operation side dependent: Group 1, 10 min in lateral decubitus then supine; Group 2, 20 min in lateral decubitus then supine; Group 3, 30 min in lateral decubitus then supine. Sensory and motor block (pinprick/modified Bromage scale) as well as skin temperature were compared between the dependent and nondependent sides. Circulatory variables were recorded for 10 min after being turned supine. RESULTS: The sensory block between dependent and nondependent sides were significantly different in Group 3. In Group 1, the level of maximum sensory block was higher than Group 3 on nondependent side. There was no difference in the number of patients having achieved Grade 3 and 0 motor block among three groups on dependent and nondependent sides. The skin temperature in lateral decubitus was significantly higher on the dependent side than nondependent side in three groups. In Groups 1 and 2, the skin temperatures of nondependent side were increased after turned supine, but that was maintained during supine position in Group 3. The circulatory variables were stable in all 50 patients. CONCLUSIONS: We conclude that when a small dose of 0.5% hyperbaric bupivacaine is injected into patients in the lateral position, complete unilateral spinal anesthesia is achieved when the patients arekeep in a lateral position for more than 30 min after spinal injection.

The Effect of Chemical Lumbar Sympathetic Neurolysis in Peripheral Arterial Occlusive Disease: Buerger's Disease vs. Arteriosclerosis Obliterans / 대한마취과학회지

BACKGROUND: A non-randomized, uncontrolled study was undertaken with a retrospective medical record review to evaluate the effect of pain relief of chemical lumbar sympathectomy in patients with peripheral vascular occlusive disease. This was conducted to assess whether the long term outcome of ischemic limbs could be changed and to identify predictable medical factors of patients who would be helped by this procedure. METHODS: A total of 47 patients with Buerger's disease (n = 20) and arteriosclerosis obliterans (n = 17) referred by vascular surgery for the management of ischemic pain were enrolled. All other conservative and surgical management efforts had already failed and were not indicated. The following were evaluated before and after the neurolytic lumbar sympathetic blocks: the stages of disease by Fontaine classification, main sites and numbers of occlusion, pain scores before and after the procedure, physical findings, amputation sites, and medications as well as amounts given and other risk factors. RESULTS: Buerger's disease tends to progress rapidly and aggressively. It is more painful than arteriosclerosis obliterans and is peripherally involved, with higher incidences of complications. Chemical sympathectomy has significant pain relief effects in both groups. Differences in long term outcome measured by amputation could not be found in both groups. No significant risk factors could be identified. No side effects were reported in both groups. CONCLUSIONS: Chemical lumbar sympathectomy has a good analgesic effect for pain in walking. This, however showed no long-term limb-saving effect.

The Pain Alterations in Terminal Cancer Patients Who Received Pain Control / 대한마취과학회지

BACKGROUND: The prevalence of cancer pain was 64% in advanced or terminal cancer patients. In the world, about 25% of all cancer patients had been died without pain control despite of severe pain. We relieved cancer pain with the three methods of treatment such as continuous epidural morphine infusion, alcohol sympathetic block and continuous epidural morphine infusion with alcohol block in the patients requested from other departments. The change of pain was investigated retrospectively. METHODS: The alteration of cancer pain in 26 terminal cancer patients were recorded in visual analogue scale from June 1996 to May 1998 retrospectively. RESULTS: Patients lived average 38.5 days from beginning of pain control. All patients complained severe pain at the point of time requested to pain clinic. But 2 days after pain control, most patients were comfortable or tolerable to pain. At 1 week before death, pain were aggravated and sometimes uncontrolled. CONCLUSIONS: At first time, cancer pain was controlled but it becomes uncontrollable and aggravated in the patients time was drawing near.

Neurolytic Blockade of the Ganglion Impar for Relief of Cancer-Related Perianal Pain: A case report / 대한마취과학회지

The perineum refers to the anatomical area immediately below the pelvis, and is comprised of diverse anatomic and somatic innervation. Although various interventions have been proposed for the management of intractable cancer-related perineal pain, their efficacy are limited because the target of nerve blocks has focused on somatic rather than sympathetic components. Recently, blockade of the ganglion impar has been introduced as an alternative means of managing intractable neoplastic perineal pain of sympathetic origin. We successfully treated a patient who had suffered from cancer-related intractable perineal pain with ganglion impar block.