• The Korean Journal of Pain
• /
• v.9 no.1
• /
• pp.210-214
• /
• 1996

Thoracic sympathetic ganglion block(TSGB) with alcohol is a traditional method for treating a variety of disease at pain clinics. But it is a difficult block to perform requiring both skill and experience. Therefore, we performed a thoracic endoscopic cauterization to evaluate the efficacy of this method. A patient suffering sever forearm and hand pain due to radius fracture of the right arm, one and half years earlier, was referred to several different orthopaedic department of various hospitals with continued aggravated symptoms. He was then admitted to our hospital's orthopaedic department. Our diagnosis, confirmed by thermography, revealed reflex sympathetic dystrophy. Patients was therefore referred to the pain clinic where treatment consisted of endoscopic thoracic sympathetic cauterization under general anesthesia. Patient was intubated with Robertashow 37 Fr. double lumen tube left sided. Left lateral and slight head up position was applied to make lesion side up. Incisions were made to penetrate trocas 5 mm diamether on 4 th intercostal space along mid axillary line and midclavicular line. Negative pressure suction on ipsilateral lung and CO2 insufflation under 10 mmHg was applied to reduce lung size. Cauterization on thoracic sympathetic chain at T3 level was done under endoscoic guide. 24 Fr. chest tube was inserted. Patient's symptoms cleared and he was satisfied with the results of this treatment.

• The Korean Journal of Pain
• /
• v.9 no.1
• /
• pp.206-209
• /
• 1996

Thoracic sympathetic nerve block has a wide range of therapeutic applications which clinicians utilize neurolytics or perform operative sympathectomy. All methods have advantages and disadvantages. We performed "thoracic sympathetic ganglion cauterization" using resectoscope as it is less invasive and more effective than traditional operative methods. Successful procedures were performed involving 2 cases of idiopathic hyperhidrosis and 1 case of sympathetically maintained pain on chest and upper extremity. We experienced failure with one case of idiopathic hyperhidrosis due to severe pleural adhesion. There was also a case of complication of periganglional hemorrhage and parenchymal lung perforation which we successfully treated.