Somatosensory evoked potentials are unchanged by reflex sympathetic dystrophy and by stellate ganglion block.
Median nerve somatosensory evoked potentials (SEPs) were monitored in patients with chronic pain before and after stellate ganglion blockade. A change caused by the syndrome or by the block would suggest that SEPs might be useful in the diagnosis and treatment of chronic pain. We observed 20 subjects. Group I (n = 10) had chronic pain not involving the upper extremity. Group II (n = 8) had reflex sympathetic dystrophy of the arm. All patients underwent unilateral stellate ganglion block using an anterior paratracheal approach. The SEPs were recorded by median nerve stimulation on the blocked (affected) side and unblocked (unaffected) side before and 30 min after the block. Recording sites were ipsilateral brachial plexus, the cervical spinal cord, and the contralateral sensory cortex. There were no between-group differences before or after the block. Paired analysis within each group showed that the SEPs were not different from baseline (unaffected side before block) at any time throughout the study. We conclude that since SEPs are not changed by the reflex sympathetic dystrophy or stellate ganglion block, they would not be useful in the evaluation of pain or in determining the effectiveness of sympathetic block. Both the pain and the block appear to involve alteration of conducting pathways separate from those monitored by median nerve SEPs.
Hyman
S A
SA
Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2125.
Parris
W C
WC
Prysi
N H
NH
Skelley
C
C
Lindsey
K
K
D000293:Adolescent; D000328:Adult; D001340:Autonomic Nerve Block; D002908:Chronic Disease; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D008475:Median Nerve; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management; D012019:Reflex Sympathetic Dystrophy / Q000150:complications / Q000503:physiopathology*; D013233:Stellate Ganglion