A low frequency, high amplitude rhythmic fluctuation of laser-Doppler skin blood flow after subarachnoid phenol block.
A 51-year-old male with a huge chondrosarcoma received subarachnoid dorsal root blocks with 10% phenol in glycerine to treat severe pain along the left leg. The dermatomes below the Th9 lost all somatic sensation on the left side after the nerve blocks, but the patient was not completely relieved from the pain. Laser-Doppler flowmetry on the toe of the left foot disclosed an increased blood flow and an abnormal fluctuation of the cutaneous capillary blood flow, i.e. a high amplitude rhythmic (HAR) wave with 2.5 to 3 cycles.min-1. The low frequency HAR wave persisted for the subsequent 3 months until a tingling sensation returned to the left leg. It would seem that some travelling roots of the sympathetic nerve were preserved from the chemical neurolysis and the remaining efferent and afferent nerve fibers were responsible for the persisting low frequency HAR wave and pain in the left leg.
Kano
T
T
Surgical Center, Kumamoto University Hospital, Japan.
Shimoda
O
O
Gotou
K
K
Morioka
T
T
D000284:Administration, Oral; D000320:Adrenergic Fibers / Q000502:physiology; D015360:Analgesia, Epidural; D001340:Autonomic Nerve Block; D002196:Capillaries / Q000294:innervation; D002746:Chlorpromazine / Q000008:administration & dosage / Q000627:therapeutic use; D002813:Chondrosarcoma / Q000503:physiopathology; D003131:Combined Modality Therapy; D003992:Dibucaine / Q000008:administration & dosage / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects; D017078:Laser-Doppler Flowmetry; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology; D019800:Phenol; D010636:Phenols; D012039:Regional Blood Flow; D012447:Sacrum; D012585:Sciatica / Q000188:drug therapy / Q000209:etiology / Q000628:therapy; D012867:Skin / Q000098:blood supply* / Q000294:innervation; D012983:Soft Tissue Neoplasms / Q000503:physiopathology; D013125:Spinal Neoplasms / Q000503:physiopathology; D014034:Toes / Q000098:blood supply* / Q000294:innervation
D009294:Narcotics; D010636:Phenols; D019800:Phenol; D008012:Lidocaine; D003992:Dibucaine; D002746:Chlorpromazine