title: Endoscopic thoracic sympathectomy for posttraumatic complex regional pain syndrome.
abstract: BACKGROUND
  Posttraumatic complex regional pain syndrome (CRPS) has a strongly negative impact on rehabilitation and activities of daily living. Treatment is most often unrewarding.
  
  
  OBJECTIVE
  To analyze the efficacy of endoscopic thoracic sympathectomy (ETS) in reducing pain and disability associated with CRPS prospectively.
  
  
  METHODS
  Over a 5-year period, 12 patients (7 females and 5 males; median age 46.5 [range 34-60 years]) with posttraumatic CRPS underwent unilateral ETS. The median duration of CRPS symptoms before ETS was 3.8 months (range 1.2-19.9). The sympathetic chain was resected from the 2nd to the 5th rib, and the nerve of Kuntz was severed. Median postoperative 16 months (range 12-40). Pain was assessed, at rest (passive) and during movement (active), using a visual analogue scale (VAS) from 0 to 10.
  
  
  RESULTS
  One patient (8%) suffered a hydrothorax and 3 patients (25%) complained of contralateral compensatory hyperhydrosis. At 1 month (n = 12), 2 months (n = 7), 6 months (n = 12), and 1 year (n = 12) after ETS, there was a significant decrease in passive and active VAS (P < 0.05). Ten out of the 12 patients (83%) needed fewer analgesics after surgery, and eight (67%) did not need analgesics at all. The median sleep duration improved significantly from a preoperative value of 2 h (range 1-7) to a postoperative value of 6.25 h (range 3.5-8) (P < 0.001). Overall, patient satisfaction was 83%.
  
  
  CONCLUSIONS
  ETS is effective at decreasing pain and improving quality of life, and should therefore be considered in the treatment of CRPS.
authors.affiliation: Department of General Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. demeykarel@hotmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Demey
authors.affiliation: Department of Traumatology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Nijs
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Coosemans
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Decaluwé
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Decker
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: De Leyn
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Van Raemdonck
authors.affiliation: Department of Traumatology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Sermon
authors.affiliation: Department of Traumatology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Broos
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Lerut
authors.affiliation: Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Nafteux
keywords: Complex regional pain syndrome; Endoscopic thoracic sympathectomy; Reflex sympathetic dystrophy; Sudeck’s dystrophy
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