JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Tran, K. M. Articles by Vu, B. Search for Related Content PubMed PubMed Citation Articles by Tran, K. M. Articles by Vu, B.

---

REGIONAL ANESTHESIA AND PAIN MEDICINE

Lumbar Sympathetic Block for Sympathetically Maintained Pain: Changes in Cutaneous Temperatures and Pain Perception

Kha M. Tran, MD^*, Steven M. Frank, MD, Srinivasa N. Raja, MD, Hossam K. El-Rahmany, MD, Lauren J. Kim, BA, and Brian Vu, MD

*The Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Medical Institutions. Baltimore, Maryland; and Department of Anesthesiology and Perioperative Care, University of California, San Francisco, California

Address correspondence and reprint requests to Srinivasa N. Raja, MD, 600 North Wolfe St., Johns Hopkins Hospital, Osler 292, Baltimore, MD 21287. Address e-mail to sraja{at}jhmi.edu

Lumbar sympathetic block (LSB) is used in the management of sympathetically maintained pain states. We characterized cutaneous temperature changes over the lower extremities after LSB. Additionally, we examined the effects of iohexol, a radio-opaque contrast medium, on temperature changes and pain relief. After institutional review board approval and written, informed consent, 28 LSBs were studied in 17 patients. Iohexol or normal saline was injected in a randomized, double-blinded fashion before bupivacaine. Lower extremity cutaneous temperatures were measured. Pain, allodynia, interference with daily function, and perceived pain relief were reported in a subset of 15 LSBs for 1 wk after the block. The distal lower extremity ipsilateral to the LSB had the greatest magnitude (8.7° ± 0.8°C) and rate (1.1° ± 0.2°C/min) of temperature change. The great toe temperature was within 3°C of core temperature within 35 min after LSB. There were no differences in temperature change between the groups. The iohexol group had greater relief of pain until the morning of the first postblock day (P = 0.002) and longer perceived relief of pain (P = 0.01). The maximum temperature of the great toe correlated with allodynia relief (P = 0.0007). Thus clinicians should expect ipsilateral toe temperatures to increase to within ~3°C of core temperature. Iohexol does not alter the efficacy of LSB and may improve relief of symptoms. The magnitude of temperature change may predict relief of allodynia.

Implications: Cutaneous toe temperatures approaching core temperature provide a useful monitor of lumbar sympathetic block and may predict relief of sympathetically maintained pain. Iohexol will not compromise temperature changes or pain relief.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999