[Pharmacological sympathetic block in complex regional pain syndrome].
OBJECTIVE
The Complex Regional Pain Syndrome (CRPS) is a chronic pain state provoked by lesions of the soft tissues or of the bony tissues (type CRPS-I or reflex sympathetic dystrophy-RSD) or by lesions of the nerves (type CRPS-II or causalgia) with vegetative alterations (perspiration, vasomotory alterations) and trophic alterations (bony cutaneous atrophy, alopecia, articular contractures). The pharmacological block of the sympathetic nerves through a peripheral vein is inserted in the multidisciplinary approach that characterizes the therapy of this syndrome.


METHODS
A retrospective survey was carried out on a group of 185 patients affected by RDS/CRPS with block of the sympathetic nerves through a peripheral vein with guanethidine. Superior limb: Inflation of the tourniquet till disappearance of the radial wrist. Cannulation of a peripheral vein with Butterfly needle n. 23. Guanethidine 10 mg, lidocaine 20 mg, sodic heparin 500 u.i, NaCl 0.9% 20 ml. Injection in 5 minutes. Permanence of the pneumatic tourniquet inflated above systolic blood pressure for 15 minutes. Deflation slowly. Inferior limb: Inflation of the tourniquet till disappearance of the pedidium wrist. Cannulation of a peripheral vein with Butterfly needle n. 23. Guanethidine 20 mg, lidocaine 40 mg, sodic heparin 1000 u.i, NaCl 0.9% 40 ml. Injection in 5 minutes. Permanence of the pneumatic tourniquet inflated above systolic blood pressure for 15 minutes. Deflation slowly.


RESULTS
The first stage (hyperemic) showed the highest incidence of remissions: (83, 33%). Even in the second stage (dystrophic) the answer to the therapy has been fundamentally positive: (53, 68%). In the third stage (atrophic) the results have been more modest: (8, 33%).


CONCLUSIONS
The block of sympathetic system with guanethidine is still an important method in the therapy of the CRPS; in fact it is surely less invading than the blocks of the stellate ganglion or of the lumbar sympathetic.
Verre
M
M
U.O. di Anestesia e Rianimazione, Ospedale Civile di Soveria Mannelli, Università degli Studi Magna Graecia, Catanzaro, Italia. marioverre@tiscalinet.it
De Santis
F
F
Glyronakis
S
S
Grande
A M
AM
Renzi
A
A
Santangelo
E
E
Tortorella
V
V
Varano
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001340:Autonomic Nerve Block / Q000379:methods; D020918:Complex Regional Pain Syndromes / Q000188:drug therapy*; D005260:Female; D006145:Guanethidine / Q000008:administration & dosage*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013565:Sympatholytics / Q000008:administration & dosage*; D013997:Time Factors
D013565:Sympatholytics; D006145:Guanethidine