Saturday 25 October 2014

Intense pain following sympathectomy, reduced inspiratory capacity

Intrapleural analgesia after endoscopic thoracic sympathectomy.

Patrícia Gomes da Silva, Daniele Cristina Cataneo, Fernanda Leite, Erica Nishida Hasimoto, Guilherme Antonio Moreira de Barros

Postgraduate Program in Anesthesiology, Botucatu School of Medicine, UNESP, Bauru, SP, Brazil.

PURPOSE To compare analgesia traditionally used for thoracic sympathectomy to intrapleural ropivacaine injection in two different doses. METHODS Twenty-four patients were divided into three similar groups, and all of them received intravenous dipyrone. Group A received intravenous tramadol and intrapleural injection of saline solution. Group B received intrapleural injection of 0.33% ropivacaine, and Group C 0.5% ropivacaine. The following aspects were analyzed: inspiratory capacity, respiratory rate and pain. Pain was evaluated in the immediate postoperative period by means of the visual analog scale and over a one-week period. RESULTS In Groups A and B, reduced inspiratory capacity was observed in the postoperative period. In the first postoperative 12 hours, only 12.5% of the patients in Groups B and C showed intense pain as compared to 25% in Group A. In the subsequent week, only one patient in Group A showed mild pain while the remainder reported intense pain. In Group B, half of the patients showed intense pain, and in Group C, only one presented intense pain. CONCLUSION Intrapleural analgesia with ropivacaine resulted in less pain in the late postoperative period with better analgesic outcomes in higher doses, providing a better ventilatory pattern.

http://lib.bioinfo.pl/meid:154350/pmid

No comments:

the amount of cell body reorganization in the spinal cord after sympathectomy

"our advice to patients must reflect the true potential outcomes"

Dear Editor,

I refer to the article on palmar hyperhidrosis by Dr Sanjay Sharma (Managing palmar hyperhidrosis, March). I feel that the adverse effects [of thoracoscopic sympathectomy] are understated by my colleague. For example, compensatory hyperhidrosis is common, and can be disabling, leading to regret about the procedure in some patients (up to 51% in one review). Reversal of the procedure is difficult and requires sural nerve transplant if the sympathetic chain is removed.

The procedure can be effective and worthwhile, but our advice to patients must reflect the true potential outcomes.

Dr Ian Gilfillan, Cardiothoracic Surgeon

http://www.medicalhub.com.au/wa-news/letters/3217-palmar-hyperhidrosis-revisited

Sympathectomy, ganglionopathies and myelopathies produce such pattern

Segmental Anhidrosis

This pattern occurs when a large, contiguous body area of sweat loss with sharply demarcated borders conforming to sympathetic or somatic dermatomes are present.

Sympathectomy, ganglionopathies and myelopathies produces such pattern. When borders are not well defined and anhidrosis not contiguous, a regional pattern is said to exist. Both postganglionic and preganglionic lesions may produce these distributions. (p.557)

Primer on the Autonomic Nervous System

edited by David Robertson, Italo Biaggioni, Geoffrey Burnstock, Phillip A. Low, Julian F.R. Paton

ETS "highlighted the disparity between what is known in practice and what appears in the literature"

The March 2004 edition was quite outstanding, with an excellent editorial reminding the reader that only good results are published. The review on thoracoscopic sympathectomy highlighted the disparity between what is known in practice and what appears in the literature.

‘Know Your Results’, the topic of the ASGBI Annual Scientific Meeting, is of outstanding importance; what is more, the surgeon has to go on knowing his/her results to ensure standards of practice do not slip.

The Journal appreciates comments and criticism and the correspondence column remains a crucial part of the BJS in its interaction between editors and reader. It is also part of the scientific process.

A more robust and incisive criticism of articles known to be flawed would prevent the retractions that have recently been published in the Lancet.

Christopher Russell, Chairman, BJS Society

Association of Surgeons of Great Britain and Ireland, ANNUAL REPORT 2004

Sympathectomy results in a significant interference in regulatory processes of the body

"ESB (whether as ETS as ETSC or ELS) generally represents a substantial interference in regulatory processes of the body. Therefore decision for this operation requires that previously conservative treatments were made. An ESB is therefore at the end of a treatment history, and never at the beginning."

Dr. Christoph H. Schick, ETS surgeon, President of the International Society of Sympathetic Surgery (ISSS)

text has been translated by google from German

http://www.dhhz.de/index.php?page=8&subPage=&section=32

our ignorance of the of the effect of sympathetic ablation

"These observations further emphasize our ignorance of the mechanisms responsible for primary hyperhidrosis and of the effect of sympathetic ablation on the function of the remaining sympathetic system."

"Only investigators who deviate from accepted standards innovate and thus advance science. Obviously, such deviations may also result in disasters;"

Statement made by the former President of the International Society of Sympathetic Surgery, and ETS surgeon, Moshe Hashmonai (Invited Commentary)

Endoscopic Lumbar Sympathectomy Following Thoracic Sympathectomy in Patients with Palmoplantar Hyperhidrosis

World J Surg (2011) 35:54–55 DOI 10.1007/s00268-010-0809-5

Endoscopic sympathectomy is not minimally invasive

The term ‘‘minimally invasive surgery’’ was initially applied to coelioscopic procedures such as laparoscopic cholecystectomy and hernia repair, thoracoscopic sympathectomy, and arthroscopy, but has since been abandoned, because doing the same operation through a smaller incision is not necessarily less invasive. The term ‘‘minimally invasive parathyroidectomy’’ does not fully convey the nature of the techniques, and, as previously debated in the wider ﬁeld of minimal-access surgery, carries connotations of increased safety that are not necessarily supported by the existing data [12].

Surg Clin N Am 84 (2004) 717–734

F. Fausto Palazzo, MS, FRCS(Gen),
Leigh W. Delbridge, MD, FACS*

Department of Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia

Sympathectomy = nerve injury

For a full story on sympathectomy and consequences, look up nerve injury or denervation

Saturday 25 October 2014

Intense pain following sympathectomy, reduced inspiratory capacity

No comments:

Post a Comment