Schürmann M, Gradl G, Wizgal I, Tutic M, Moser C, Azad S, Beyer A
Department of Surgery, Ludwig-Maximilians-University, Munich, Germany.
Clin J Pain. 2001 Mar;17(1):94-100. doi: 10.1097/00002508-200103000-00012.
The efficacy of peripheral sympathetic interruption after stellate ganglion blockade was assessed by a sympathetic function test. Results were compared with clinical signs such as temperature changes, pain reduction, and the development of Horner syndrome to evaluate the correlation with clinical investigations.
Stellate ganglion blockade with local anesthetics was carried out via an anterior paratracheal approach in 33 patients suffering from complex regional pain syndrome type I. Patients were examined before and after the procedure. For assessment of sympathetic nervous function, the vasoconstrictor response to sympathetic stimuli was assessed using laser Doppler flowmetry. Clinical parameters like surface temperature changes (thermography), pain relief (visual analogue scale), and Horner syndrome were monitored.
Twenty-three (70%) of 33 patients developed an increase in temperature difference between the treated hand and the contralateral hand of more than 1.5 degreesC after the procedure, which is a clinical sign of sympathicolysis. In 48% (n = 11) of these patients, the sympathetic function test showed an undisturbed sympathetic nervous function. In 10 patients, no significant increase in temperature difference was observed. Although these patients presented with a normal sympathetic vasoconstrictor response, 4 felt pain relief of more than 50%, suggesting a placebo effect. Only 7 patients with pain relief revealed both clinical sympathicolysis and extinguished sympathetic nervous function and qualified for sympathetically maintained pain.
Clinical investigation is not reliable in the assessment of stellate ganglion blockade. Proof of sympathetically maintained pain based on pain relief after stellate ganglion blockade is not conclusive.
通过交感神经功能测试评估星状神经节阻滞后外周交感神经阻断的疗效。将结果与诸如体温变化、疼痛减轻和霍纳综合征的出现等临床体征进行比较，以评估与临床检查的相关性。
对33例患有I型复杂性区域疼痛综合征的患者采用气管旁前路进行局部麻醉下的星状神经节阻滞。在操作前后对患者进行检查。为评估交感神经功能，使用激光多普勒血流仪评估对交感神经刺激的血管收缩反应。监测诸如体表温度变化（热成像）、疼痛缓解（视觉模拟评分）和霍纳综合征等临床参数。
33例患者中有23例（70%）在术后患手与对侧手之间的温差增加超过1.5℃，这是交感神经松解的临床体征。在这些患者中，48%（n = 11）的交感神经功能测试显示交感神经功能未受干扰。10例患者未观察到温差有显著增加。尽管这些患者表现出正常的交感神经血管收缩反应，但有4例疼痛缓解超过50%，提示存在安慰剂效应。只有7例疼痛缓解的患者同时出现了临床交感神经松解和交感神经功能消失，符合交感神经维持性疼痛的标准。
在评估星状神经节阻滞时，临床检查不可靠。基于星状神经节阻滞后疼痛缓解来证明交感神经维持性疼痛并不确凿。
