title: Successful intravenous regional sympathetic blockade (Bier's Block) with guanethidine and lidocaine in a patient with advanced Buerger's Disease (thromboangiitis obliterans)--a case report.
abstract: A 65-year-old man, a heavy smoker with Buerger's disease (thromboangiitis obliterans), presented to this department with persistent severe ischemic rest pain at the fingers of his right hand, not responding to oral treatment with vasodilators and analgesics. Critical blood flow was discovered in the middle, ring, and little finger, with ischemic ulcerations apparent in the fingertips of these 3 fingers. The distal phalanx of the little finger had been amputated 6 months before because of gangrenous necrosis. In an attempt to avoid further disabling amputations, the patient received 3 series of Bier's block sessions with guanethidine and lidocaine according to a specific protocol. Marked increase in finger blood flow was induced even after the first series, and complete disappearance of both fingertip ulcerations and ischemic rest pain was achieved. No side effects were observed. The above-described method in a patient with advanced Buerger's disease resulted in excellent pain relief and full restoration of both blood flow and function of the affected fingers.
authors.affiliation: Department of Vascular Surgery, Athens University Medical School, General Prefecture Hospital of Larissa, Larissa, Greece. paraskevask@hotmail.com
authors.forename: Kosmas I
authors.initials: KI
authors.lastname: Paraskevas
authors.forename: Aikaterini A
authors.initials: AA
authors.lastname: Trigka
authors.forename: Maria
authors.initials: M
authors.lastname: Samara
mesh_terms: D000368:Aged; D001340:Autonomic Nerve Block; D005385:Fingers / Q000098:blood supply*; D005734:Gangrene / Q000517:prevention & control; D006145:Guanethidine / Q000494:pharmacology; D006801:Humans; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D010146:Pain / Q000188:drug therapy; D020127:Recovery of Function; D012039:Regional Blood Flow / Q000187:drug effects; D013919:Thromboangiitis Obliterans / Q000628:therapy*
chemical_list: D008012:Lidocaine; D006145:Guanethidine