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Sympathectomy for Causalgia: Patient Selection and Long-term Results

Sympathectomy for Causalgia: Patient Selection and Long-term Results Abstract • Thirty-four sympathectomies were performed for causalgic pain. Overt extremity trauma was the precipitating event in only 26%. In 48%, nerve compression requiring surgical relief preceded the onset of the pain; most common lumbar disk surgery (37%). In the remainder (26%), miscellaneous vascular conditions contributed. Satisfactory immediate relief was obtained in 97% and 61% were completely relieved of pain initially. There were no deaths, 10% wound complication rate, and one instance of Horner's syndrome. Postsympathectomy neuralgia occurred in close to 40%, lasted a little over a month on the average but did not persist beyond ten weeks. In extended follow-up, only one patient failed to sustain satisfactory relief (97% of those relieved, 94% of the total) and 84% continued to enjoy the same degree of relief as they had immediately preoperatively. This frequency, degree, and duration of benefit establishes causalgic pain as one of the best indications for surgical sympathectomy. (Arch Surg 1987;122:668-672) References 1. Owens JC: Causalgia : Am Surg 1957;23:636-640. 2. Owens JC: Indications for lumbar sympathectomy , in Dale WA (ed): The Management of Arterial Occlusive Disease , Chicago, Year Book Medical Publishers Inc, 1971. 3. Roos DB: Sympathectomy for the upper extremities , in Rutherford RB (ed): Vascular Surgery . Philadelphia, WB Saunders Co, 1984, pp 725-730. 4. Mitchell SW, Morehouse GR, Kern WW: Gunshot Wounds and Other Injuries of Nerves . New York, JB Lippincott, 1869, p 164. 5. Mitchell SW: On the diseases of nerves, resulting from injuries , in Flint A (ed): Contributions Relating to the Causation and Prevention of Disease and to Camp Diseases . New York, US Sanitary Commission Memoirs, 1867, p 412. 6. Homan J: Minor causalgia: A hypesthetic neurovascular syndrome . N Engl J Med 1940;222:870.Crossref 7. Patman RD, Thompson JE, Persson AV: Management of posttraumatic pain syndromes: Report of 113 cases . Ann Surg 1973;177:780.Crossref 8. Wirth FP, Rutherford RB: A civilian experience with causalgia . Arch Surg 1970;100:633-638.Crossref 9. Thompson JE: The diagnosis and management of post-traumatic pain syndromes (causalgia) . Aust NZ J Surg 1979;49:299-304.Crossref 10. Drucker WR, Hubag CA, Holden UD: Pathogenesis of post-traumatic sympathetic dystrophy . Am J Surg 1959;87:454-465.Crossref 11. Sanderson CJ: Chemical lumbar sympathectomy with radiologic assessment . Ann R Coll Surg Engl 1981;63:420-422. 12. Walsh JA, Glynn CJ, Cousins MJ, et al: Blood flow, sympathetic activity and pain relief following lumbar sympathetic blockade and surgical sympathectomy . Anesth Intensive Care 1984;13:18-24. 13. Collins GJ, Rich NM, Clagett GP, et al: Clinical results of lumbar sympathectomy . Am Surg 1981;47:31-35. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Sympathectomy for Causalgia: Patient Selection and Long-term Results

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Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1987.01400180050009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Thirty-four sympathectomies were performed for causalgic pain. Overt extremity trauma was the precipitating event in only 26%. In 48%, nerve compression requiring surgical relief preceded the onset of the pain; most common lumbar disk surgery (37%). In the remainder (26%), miscellaneous vascular conditions contributed. Satisfactory immediate relief was obtained in 97% and 61% were completely relieved of pain initially. There were no deaths, 10% wound complication rate, and one instance of Horner's syndrome. Postsympathectomy neuralgia occurred in close to 40%, lasted a little over a month on the average but did not persist beyond ten weeks. In extended follow-up, only one patient failed to sustain satisfactory relief (97% of those relieved, 94% of the total) and 84% continued to enjoy the same degree of relief as they had immediately preoperatively. This frequency, degree, and duration of benefit establishes causalgic pain as one of the best indications for surgical sympathectomy. (Arch Surg 1987;122:668-672) References 1. Owens JC: Causalgia : Am Surg 1957;23:636-640. 2. Owens JC: Indications for lumbar sympathectomy , in Dale WA (ed): The Management of Arterial Occlusive Disease , Chicago, Year Book Medical Publishers Inc, 1971. 3. Roos DB: Sympathectomy for the upper extremities , in Rutherford RB (ed): Vascular Surgery . Philadelphia, WB Saunders Co, 1984, pp 725-730. 4. Mitchell SW, Morehouse GR, Kern WW: Gunshot Wounds and Other Injuries of Nerves . New York, JB Lippincott, 1869, p 164. 5. Mitchell SW: On the diseases of nerves, resulting from injuries , in Flint A (ed): Contributions Relating to the Causation and Prevention of Disease and to Camp Diseases . New York, US Sanitary Commission Memoirs, 1867, p 412. 6. Homan J: Minor causalgia: A hypesthetic neurovascular syndrome . N Engl J Med 1940;222:870.Crossref 7. Patman RD, Thompson JE, Persson AV: Management of posttraumatic pain syndromes: Report of 113 cases . Ann Surg 1973;177:780.Crossref 8. Wirth FP, Rutherford RB: A civilian experience with causalgia . Arch Surg 1970;100:633-638.Crossref 9. Thompson JE: The diagnosis and management of post-traumatic pain syndromes (causalgia) . Aust NZ J Surg 1979;49:299-304.Crossref 10. Drucker WR, Hubag CA, Holden UD: Pathogenesis of post-traumatic sympathetic dystrophy . Am J Surg 1959;87:454-465.Crossref 11. Sanderson CJ: Chemical lumbar sympathectomy with radiologic assessment . Ann R Coll Surg Engl 1981;63:420-422. 12. Walsh JA, Glynn CJ, Cousins MJ, et al: Blood flow, sympathetic activity and pain relief following lumbar sympathetic blockade and surgical sympathectomy . Anesth Intensive Care 1984;13:18-24. 13. Collins GJ, Rich NM, Clagett GP, et al: Clinical results of lumbar sympathectomy . Am Surg 1981;47:31-35.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jun 1, 1987

References