Sympathetic Block

Abstract: The hemodynamic and metabolic effects of a total sympathetic block and of the infusion of l-epinephrine or l-norepinephrine were studied in 27 euthyroid dogs and in 31 thyroid-fed dogs. The physiologic changes produced by increased concentrations of the thyroid hormones were abolished by preventing the reflex release of epinephrine and norepinephrine with a total sympathetic block. The inotropic, chronotropic and calorigenic effects of l-epinephrine and of l-norepinephrine were found to be increased by thyroid feeding. It is concluded that there is a dynamic interrelationship between the thyroid hormones and those of the adrenal medulla and sympathetic nerve endings. The hemodynamic and metabolic changes of thyrotoxicosis are not the result of the isolated activity of the thyroid hormones, but rather are due to the physiologic effects of epinephrine and norepinephrine, as augmented by the thyroid hormones. Studies indicate that l-norepinephrine is the predominant mediator of the changes produced by thyroi...

Abstract: Background and Aims: The second sympathetic thoracic ganglion has long been regard­ ed as the most important structure in all sympathetic procedures for any indication, be it hand sweating, blushing, or social phobia Earlier, we had found an interesting new basis for the selection of more specific methods in individual disorders The aim of the present study was to either confirm the old theory or to bring forward a more appropri­ ate theory for sympathetic surgery to be used as a classified method Material and Methods: Altogether 193 patients were treated in Taiwan and 55 in Fin­ land according to the new selective principle Endoscopic sympathetic block of the sec­ ond thoracic ganglion (ESB 2) was used as a method for conflicted type of social phobia or blushing for 25 patients ESB 3 was used for facial sweating and blushing for 55 pa­ tients ESB 4 was used for hand and axillary sweating for 168 patients Reflex sweating was taken as the most important sign of unsuccessful surgery Results: All patients benefited of the procedure in their presenting symptonls Four of 25 cases in ESB 2 -group and three of 55 cases in ESB 3 -group had unacceptable reflex sweating No patient with reflex sweating was found in ESB 4 -group These results confirm our previous findings, that sympathetic nerves innervate the human body in similar dermatome fashion as the peripheral nervous system Accord­ ing to this, we organized the various sympathetic disorders into three main categories: those restricted within the head, like conflicted type social phobia and conflicted type blushing, to Group 1; those on the head and face, like sweating with or without blush­ ing, to Group 2; and those in the hands and underarms to Group 3 The principle of different surgical procedures for different disorders of the sympathetic system are pro­ posed: ESB 2 for Group 1, ESB 3 for Group 2, and ESB 4 for Group 3 disorders Conclusions: We call this new classification uLin-Telaranta classification" Not only the incidence of complication rates is lowered but also the side effects can be predicted by the Lin-Telaranta classification in sympathetic surgery

Abstract: The sympathetic nervous system has been implicated in numerous pain syndromes ranging from neuropathic pain to vascular pain to visceral pain. In light of this, sympathetic ganglia have been the target of local anesthetic blockade to determine the sympathetic role in the transmission of pain. If analgesia is afforded with local anesthetic blockade, chemical or thermal neurolysis have been utilized to attempt to provide long-term relief. Despite frequent use of minimally invasive sympathetic blocks and neurolysis by pain practitioners, their efficacy for providing analgesia has been sparsely reported in the literature. Many case reports and case series have been published, but few placebo-controlled, blinded studies exist. This manuscript will review the literature on sympathetic blocks and summarize existing studies for each of the sympathetic blocks. The goal is to provide past, current, and future pain physicians with evidence that they can use to provide appropriate care for their patients.