Lumbar sympathectomy: a single needle technique.

A single-needle lumbar sympathectomy technique is described which uses the tip of the 12th rib as a marker to determine the appropriate position for the insertion of the needle. Radiological screening is used to control final placement at the body of L3 and to visualize spread of radio-opaque phenol in the correct prevertebral plane. Following sympathectomy, fore-foot temperatures increased by a mean of 3 degrees C and lower leg blood flow doubled, these being accompanied by significant increases in ankle pressure index and venous oxygen tensions in the affected foot. These physiological improvements brought about resolution of ischaemic foot pain in 70% of patients at follow up 1 month later. As these results were not significantly different from those obtained in patients having two-needle sympathectomy, blockade with a single needle under x-ray control is considered to be an effective technique for the performance of neurolytic sympathectomy.

Electrical stimulation in the relief of pain: a pilot study.

A group of 26 patients who suffered from chronic pain resistant to other therapeutic measures, were given electrical stimulation in two forms. The first utilised penetrating acupuncture needles connected to a standard Chinese electrical impulse generator and the second method employed American transcutaneous stimulators with conducting skin electrodes. At long term follow-up 50 percent of patients treated exhibited sustained relief--20 percent when the device was used alone and a further 30 percent when it was combined with other forms of specific pain therapy. There was no difference in the response to needle acupuncture or transcutaneous stimulation. The best response was seen in patients with neuralgic disorders and painful musculo skeletal syndromes affecting the cervico thoracic region.

Management of intractable pain: the scope and role of nerve blocks: review of one year's experience.

This paper presents the first one year's experience of nerve blocking procedures carried out for the relief of intractable pain. The control of pain is complex and has led to the development of Pain Clinics employing the skills of different specialties. The scope and organisation of such a clinic developed at Auckland Hospital is outlined. Some 103 patients were referred with intractable pain from cancer, musculo-skeletal disorders, neurogenic causes and ischaemic causes and ischaemic problems. Of these, 55 percent derived complete relief. Breakdown of results demonstrate that over 70 percent of patients in the groups of pain of neurogenic and ischaemic origin had complete relief of pain. Recognised complications of major nerve blocking procedures were encountered in a small percentage of patients, but these caused no great concern. Nerve blocks have a definite place in the treatment of chronic pain and form an important adjunct to the overall management.