The Internet Journal of Minimally Invasive Spinal Technology™ ISSN: 1937-8254

The Internet Journal of Minimally Invasive Spinal Technology is the official online journal of ISMISS/SICOT (International Society of Minimally Invasive Spinal Surgery, affiliate of SICOT) and AAMISMS (American Academy of Minimally Invasive Spine Surgery and Medicine)

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Interventional causalgia treatment "image guided"

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Jalal Jalal Shokouhi
Jamejam Medical Center, Iranian Society Of Radiology

Citation: J. Shokouhi : Interventional causalgia treatment "image guided". The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4

Abstract

Interventional causalgia treatment "Image guided" Causalgia, complex regional pain syndrome or reflex sympathetic dystrophy treated in war Injured patients. In 1905 first sympathetic trunk block made by Selheim and followed later with blocks by Lawen, Kappis and Finsterer. The common sympathetic ganglion blocks include: 1. Stellate ganglion block for upper extremity and lower facial and neck pain. 2. Celiac ganglion block for pain of the upper abdomen. 3. Lumbar sympathetic block for pain related to the lower extremities. 4. Impar ganglion block for pain in the lower pelvis and perineal regions. Lumbar sympathetic block or blockage and ethanol sympathectomy may be helpful in cases of lower extremity reflex sympathetic dystrophy or causalgia of war injured patients. The lumbar sympathetic plexus extends from L2 down to L5. The best target is anterior of L2 vertebrae. A postero-anterior approach, slightly off midline is made in all patients. Injection of iodine contrast medium (Air bubble in hypersensitive patients) confirms safety of injection site (to save Aorta, IVC and ureter in the retroperitoneum). All patients guided by X-ray CT Scan. 68 Adult patients treated by this method, 18 persons were operated before by surgical sympathectomy methods and vascular surgeons for many times but pain recurred again. In orthopedic surgical and interventional procedures: Linson, Leffert and Todd reported use of Lidocaine and Corticosteroid with 89% pain lessening in causalgia and 80% treatment in other dystrophic variants. They used sequentional sympathetic blocks. All our patients had gunshot wounds or metallic fragments from explosive army materials. With high velocity injuries spontaneous pain recovery takes longer time (3-9 months for slow velocity injuries). After this period there is indication for surgery or intervention. We used Bupivicain 0.5% (20 cc) and Ethanol 65% (10-16 cc). Pain reduction gained in all patients about 85%. All of patients treated by simple procedure except few patients with subsequent Ethanol sympathectomy after successful Bupivicain or Marcain sympathetic block. Speaker: Jalal Shokouhi Jalal-M.D.* Fatehi Mansour- M.D.* Ameri Aliakbar-M.D.* +98-9121137884 +98-21-88317260 jalaljalalshokouhi@hotmail.com *Iranian society of radiology,Tehran, Iran

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	The Internet Journal of Minimally Invasive Spinal Technology™ ISSN: 1937-8254 \| Home \| Editors \| Current Issue \| Archives \| Instructions for Authors \| Disclaimer \| Share with others \| The Internet Journal of Minimally Invasive Spinal Technology is the official online journal of ISMISS/SICOT (International Society of Minimally Invasive Spinal Surgery, affiliate of SICOT) and AAMISMS (American Academy of Minimally Invasive Spine Surgery and Medicine) Interventional causalgia treatment "image guided" Read printer friendly Subscribe in a reader Share with others Jalal Jalal Shokouhi Jamejam Medical Center, Iranian Society Of Radiology Citation: J. Shokouhi : Interventional causalgia treatment "image guided". The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4 Abstract Interventional causalgia treatment "Image guided" Causalgia, complex regional pain syndrome or reflex sympathetic dystrophy treated in war Injured patients. In 1905 first sympathetic trunk block made by Selheim and followed later with blocks by Lawen, Kappis and Finsterer. The common sympathetic ganglion blocks include: 1. Stellate ganglion block for upper extremity and lower facial and neck pain. 2. Celiac ganglion block for pain of the upper abdomen. 3. Lumbar sympathetic block for pain related to the lower extremities. 4. Impar ganglion block for pain in the lower pelvis and perineal regions. Lumbar sympathetic block or blockage and ethanol sympathectomy may be helpful in cases of lower extremity reflex sympathetic dystrophy or causalgia of war injured patients. The lumbar sympathetic plexus extends from L2 down to L5. The best target is anterior of L2 vertebrae. A postero-anterior approach, slightly off midline is made in all patients. Injection of iodine contrast medium (Air bubble in hypersensitive patients) confirms safety of injection site (to save Aorta, IVC and ureter in the retroperitoneum). All patients guided by X-ray CT Scan. 68 Adult patients treated by this method, 18 persons were operated before by surgical sympathectomy methods and vascular surgeons for many times but pain recurred again. In orthopedic surgical and interventional procedures: Linson, Leffert and Todd reported use of Lidocaine and Corticosteroid with 89% pain lessening in causalgia and 80% treatment in other dystrophic variants. They used sequentional sympathetic blocks. All our patients had gunshot wounds or metallic fragments from explosive army materials. With high velocity injuries spontaneous pain recovery takes longer time (3-9 months for slow velocity injuries). After this period there is indication for surgery or intervention. We used Bupivicain 0.5% (20 cc) and Ethanol 65% (10-16 cc). Pain reduction gained in all patients about 85%. All of patients treated by simple procedure except few patients with subsequent Ethanol sympathectomy after successful Bupivicain or Marcain sympathetic block. Speaker: Jalal Shokouhi Jalal-M.D.* Fatehi Mansour- M.D.* Ameri Aliakbar-M.D.* +98-9121137884 +98-21-88317260 jalaljalalshokouhi@hotmail.com *Iranian society of radiology,Tehran, Iran This article was last modified on Fri, 03 Jul 09 14:16:49 -0500 This page was generated on Sat, 07 Nov 09 11:51:21 -0600, and may be cached.
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