The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.

Spinal cord infarction occurring during thoraco-lumbar sympathectomy
J Neurol Neurosurg Psychiatry 1963;26:418-421 doi:10.1136/jnnp.26.5.418

Saturday, November 29, 2014

"Sympathectomy is a destructive procedure that interrupts the sympathetic nervous system

Cervico-thoracic or lumbar sympathectomy for neuropathic pain | Cochrane Summaries: "Sympathectomy is a destructive procedure that interrupts the sympathetic nervous system. Chemical sympathectomies use alcohol or phenol injections to destroy sympathetic nervous tissue (the so-called "sympathetic chain" of nerve ganglia). Surgical ablation can be performed by open removal or electrocoagulation (destruction of tissue with high-frequency electrical current) of the sympathetic chain, or by minimally invasive procedures using thermal or laser interruption. Nerve regeneration commonly occurs following both surgical or chemical ablation, but may take longer with surgical ablation.

This systematic review found only one small study (20 participants) of good methodological quality, which reported no significant difference between surgical and chemical sympathectomy for relieving neuropathic pain. Potentially serious complications of sympathectomy are well documented in the literature, and one (neuralgia) occurred in this study.

The practice of sympathectomy for treating neuropathic pain is based on very weak evidence. Furthermore, complications of the procedure may be significant."

'via Blog this'

Tuesday, November 25, 2014

Stellate ganglion block alleviates anxiety, depression

Among veterans with post-traumatic stress disorder, treatment with a single stellate ganglion block could help alleviate anxiety, depression and psychological pain rapidly and for long-term use, according to results presented at the American Society for Anesthesiologists Annual Meeting.
Researchers performed a single right-sided stellate ganglion block (SGB) using 7 mL of 2% lidocaine and 0.25% bupivacaine under fluoroscopic guidance on 12 veterans with military-related, chronic extreme post-traumatic stress disorder (PTSD) with hyperarousal symptoms. At baseline, 1 week, 1 month, 3 months and 6 months post-block, PTSD symptoms were assessed using the Clinician Administered PTSD Scale (CAPS) score and the Post-traumatic Stress Self Report (PSS-SR) scale. Depressive symptoms were assessed with the Beck Depression Inventory version 2. Anxiety related symptoms with a generalized anxiety scale score and the State-Trait Anxiety Index and psychological pain with the Mee-Bunney scale.
Study results showed the block was greatly effective in 75% of participants, with a positive effects taking effect often within minutes of SGB. At week 1, there was significant reduction of both CAPS and PSS-SR and researchers found CAPS approached normal-to-mild PTSD levels by 1 month. Anxiety, depression and psychological pain scores also were significantly reduced by the block, according to study results. Overall, positive effects remained evident at 3 months, but were generally gone by 6 months.
Alkire MT. A1046. Presented at: American Society for Anesthesiologists Annual Meeting;  Oct. 11-15, 2014; New Orleans.