Forte Antonio J, Boczar Daniel, Huayllani Maria T, Lu Xiaona, McLaughlin Sarah A
Plastic Surgery, Mayo Clinic Florida - Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Jacksonville, USA.
Division of Plastic Surgery, Yale University, New Haven, USA.
Cureus. 2019 Sep 19;11(9):e5700. doi: 10.7759/cureus.5700.
Although the sympathetic nerve system has been described as a modulator of lymphatic circulation, it has not been targeted in the treatment of lymphedema. We conducted a systematic review of publications assessing the use of sympathetic nerve block in lymphedema treatment. We hypothesized that sympathetic nerve block may be a promising treatment option for lymphedema patients. We conducted a comprehensive systematic review of the published literature on the use of sympathetic nerve block in lymphedema treatment using the PubMed database. Eligibility criteria excluded papers that reported other types of lymphedema treatment or any other anesthesiology procedure. Abstracts, presentations, reviews, and meta-analyses were also excluded. Extracted data included the year of study, country, author affiliation, type of study, patient characteristics, nerve block technique, and key findings. From 81 potential papers, eight studies fulfilled the eligibility criteria. All papers identified were clinical, reporting on a total of 187 patients. Sympathetic nerve block was proposed with local anesthetics, whether or not associated with triamcinolone. Treatment with a nerve block promoted lymphedema improvement expressed by decreased limb circumference and patient-reported outcomes. Large randomized clinical trials are still pending, but sympathetic nerve block seems to be a promising alternative for lymphedema patients who do not respond to conservative therapy.
尽管交感神经系统被描述为淋巴循环的调节者，但它尚未成为淋巴水肿治疗的靶点。我们对评估交感神经阻滞在淋巴水肿治疗中应用的出版物进行了系统综述。我们假设交感神经阻滞可能是淋巴水肿患者一种有前景的治疗选择。我们使用PubMed数据库对已发表的关于交感神经阻滞在淋巴水肿治疗中应用的文献进行了全面的系统综述。纳入标准排除了报告其他类型淋巴水肿治疗或任何其他麻醉学程序的论文。摘要、报告、综述和荟萃分析也被排除。提取的数据包括研究年份、国家、作者所属机构、研究类型、患者特征、神经阻滞技术和主要发现。从81篇潜在论文中，有8项研究符合纳入标准。所有确定的论文均为临床研究，共报告了187例患者。无论是否与曲安奈德联合使用，均使用局部麻醉剂进行交感神经阻滞。神经阻滞治疗促进了淋巴水肿的改善，表现为肢体周长减小和患者报告的结果。大型随机临床试验仍在进行中，但对于对保守治疗无反应的淋巴水肿患者，交感神经阻滞似乎是一种有前景的替代治疗方法。
