Bonelli S, Conoscente F, Movilia P G, Restelli L, Francucci B, Grossi E
Second Service of Anaesthesia, Pain Relief Unit, Legnano General Hospital, via Candiani 2, 20025 - Legnano MilanItaly Ciba-Geigy, Medical Department, Strada Statale 233, Km 20.5, 21040-Origgio VareseItaly.
Pain. 1983 Jul;16(3):297-307. doi: 10.1016/0304-3959(83)90118-5.
Regional intravenous guanethidine blocks and stellate ganglion blocks have been compared in a randomized trial. Nineteen patients, randomly allocated to two groups of therapy and exhibiting severe reflex sympathetic dystrophy following peripheral nerve lesions, have been treated. The performance of the intravenous guanethidine block is of longer duration and superior to stellate ganglion block, as regards some early pharmacological effects (skin temperatures and amplitude of plethysmographic waves recorded before blockade and 15 min, 60 min, 24 h, 48 h after institution of the block). In fact the intravenous guanethidine group shows a persistent and significant increase of the skin temperature and of the plethysmographic traces in the blocked side 24 h and 48 h after blockade in comparison with the patients treated with stellate ganglion block. Concerning the therapeutic effects (changes in pain scores and clinical signs--hyperpathia, allodynia, vasomotor disturbances, trophic changes, oedema and limited motion), recorded at the end of treatment and 1 month and 3 months follow-up, an intravenous guanethidine block carried out every 4 days up to a total of 4 blocks is comparable with a stellate ganglion block every day up to a total of 8 blocks. The results of this study show that regional sympathetic block with guanethidine is a good therapeutic tool in the treatment of reflex dystrophies, especially on account of its negligible risks and contraindications.
在一项随机试验中，对区域静脉注射胍乙啶阻滞和星状神经节阻滞进行了比较。19例患者被随机分配到两组治疗，这些患者在周围神经损伤后出现严重的反射性交感神经营养不良。就一些早期药理作用（阻滞前、阻滞开始后15分钟、60分钟、24小时、48小时记录的皮肤温度和体积描记波幅度）而言，静脉注射胍乙啶阻滞的持续时间更长，优于星状神经节阻滞。事实上，与接受星状神经节阻滞治疗的患者相比，静脉注射胍乙啶组在阻滞后24小时和48小时，阻滞侧的皮肤温度和体积描记曲线持续且显著升高。关于在治疗结束时以及随访1个月和3个月时记录的治疗效果（疼痛评分和临床体征的变化——痛觉过敏、感觉异常、血管运动障碍、营养改变、水肿和活动受限），每4天进行一次静脉注射胍乙啶阻滞，共进行4次阻滞，与每天进行一次星状神经节阻滞，共进行8次阻滞相当。这项研究的结果表明，胍乙啶区域交感神经阻滞是治疗反射性营养不良的一种良好治疗手段，尤其是因其风险和禁忌证可忽略不计。
