CLINICAL REASSESSMENT OF NEUROLYTIC THORACIC SYMPATHETIC GANGLION BLOCKADE-WITH SPECIAL COMPARATIVE REFERENCE TO THE PROCEDURES

Abstract

Neurolytic thoracic sympathetic ganglion blockade has only relatively recently been introduced as a clinical therapeutic strategy. To cast light on the efficacy of this procedure, data for 111 patients (21-78 years old, 132 affected extremities/sites) were analyzed. Methods : A comparative assessment was performed with fluoroscopic and contrast-radiographic observation of the blockade using chemical or thermocoagulative approaches, with anterior paratracheal or posterior paravertebral injection sites and upper-thoracic or lower-thoracic regions. Results : Chemical neurolytic sympathetic ganglion blockade was applied to patients 217 times, and radiofrequency thermocoagulation at 90℃ for 180 seconds a total of 64 times. Statistically, chemical neurolytiques proved longer lasting than thermocoagulation neurolytiques but no significant differences between anterior and posterior approaches were observed regarding the period of influence. Lower-thoracic injection was associated with a longer effective duration than evident with the upper-thoracic group. Complications were observed with chemical neurolytique including two cases of pneumothorax, two cases of Horner's syndrome and one case of nerve injury, despite radiographic evaluation. Conclusions : Chemical or radiofrequency thermocoagulation neurolytique can be extensively applied to patients suffering from persistent intractable pain in the cervical or thoracic regions, but performance under fluoroscopy is an absolute requiement.