Percutaneous upper thoracic radiofrequency sympathectomy in Raynaud phenomenon: a comparison of T2/T3 procedure versus T2 lesion with phenol application.
OBJECTIVE
Percutaneous radiofrequency (RF) thoracic sympathectomy is an alternative method to surgical procedures for the treatment of acral ischemia in Raynaud phenomenon. The procedure is indicated if conservative therapy fails to provide sufficient relief. The aim of this study was to compare classic T2 and T3 RF thermolesioning with a less invasive procedure at the level of T2 only.


METHODS
Fifty adult patients, American Society of Anesthesiologists (ASA) classification I to III, were randomly assigned to 1 of 2 groups. T2 and T3 thoracic RF thermolesion was performed in 1 group, whereas T2 thermolesion with local application of 0.5 mL of 6% phenol was delivered in the second group. Changes in cold perception, pain, and quality of life were assessed using a questionnaire. Blood circulation in the upper extremity was evaluated using infrared thermography. Patients were observed for a period of 3 months.


RESULTS
A significant decrease in pain according to visual analog scale (P < 0.001), increase in peripheral temperature in the upper extremities (P < 0.001), and improvement in quality of life were observed in both groups of patients after the procedure. Susceptibility to cold-provoked vasospasm was not significantly affected in either group. There was no significant difference between the 2 groups in any parameter apart from the duration of the procedure.


CONCLUSIONS
Thoracic RF upper sympathectomy is an effective method in the treatment of resistant forms of Raynaud phenomenon. A single-shot procedure at the level of T2 may be preferable because of the shorter procedure duration of this technique.
Gabrhelik
Tomas
T
Department of Anaesthesia and Intensive Care, University Hospital, Olomouc, Czech Republic. gabrhelikt@yahoo.co.uk
Michalek
Pavel
P
Adamus
Milan
M
Berta
Emil
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D017288:Pain Threshold; D017060:Patient Satisfaction; D019800:Phenol / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D011928:Raynaud Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D011795:Surveys and Questionnaires; D013562:Sympathectomy / Q000009:adverse effects / Q000379:methods*; D013697:Thermosensing; D013904:Thoracic Vertebrae / Q000294:innervation*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D019800:Phenol