Abstract
Purpose
To present a case of unexpected bilateral pain relief following unilateral thoracic percutaneous sympathectomy.
Clinical findings
We present a case report where severe ischemic pain due to paraneoplastic Raynauďs syndrome with distal gangrene was successfully treated by means of percutaneous thoracic sympathectomy. A unilateral T2, T3 radiofrequency sympathectomy combined with small volume phenol injection resulted in unexpected bilateral pain relief.
Conclusion
Our observations from this case report suggest possible crossover of sympathetic innervation at the cervical nd thoracic levels. Percutanenous thoracic radiofrequency ympathectomy is a feasible option for the treatment of refractory ischemic upper limb pain.
Résumé
Objectif
Présenter un cas de contrôle bilatéral inattendu de la douleur à la suite ďune sympathectomie thoracique percutanée.
Constatations cliniques
Nous présentons un cas où une douleur ischémique sévère causée par un syndrome paranéoplasique de Raynaud, accompagnée de gangrène distale, a été traitée avec succès par une sympathectomie thoracique percutanée. La sympathectomie unilatérale à radiofréquence en T2, T3 combinée à une injection de phénol de faible volume a produit un contrôle bilatéral inattendu de la douleur.
Conclusion
Nos observations suggèrent une innervation sympathique croisée possible aux niveaux cervical et thoracique. La sympathectomie thoracique percutanée peut traiter la douleur ischémique réfractaire aux membres supérieurs.
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Gofeld, M., Faclier, G. Bilateral pain relief after unilateral thoracic percutaneous sympathectomy. Can J Anesth 53, 258–262 (2006). https://doi.org/10.1007/BF03022212
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DOI: https://doi.org/10.1007/BF03022212