Combined thoracic and lumbar sympathetic nerve blocks guided by CT in treating palmar and plantar hyperhidrosis

Abstract

Objective To evaluate the clinical effects of CT guided thoracic sympathetic nerve block combined with lumbar sympathetic nerve block on palmar and plantar hyperhidrosis. Methods Twenty-three patients with palmar and plantar hyperhidrosis, received combined thoracic and lumbar sympathetic nerve blocks in our hospital from January 2013 to December 2014, were chosen. Under CT guidance, thorocic intervertebral puncture was performed between T3 and T4 till the needle tip reached the spot around T4 and above capitis costae; lumbar intervertebral puncture was performed between L2 and L3 till the needle tip reached the lateral side of L3 and the anterior side of the psoas muscle. Two mL and 3 mL 1% lidocaine containing contrast agent iohexol were injected adjacently to thoracic and lumbar sympathetic nerves, respectively. The injected liquid was observed to be distributed in front of T4 capitis costae, or between the psoas muscle and the verterbrae of L3. The patient's finger and toe tip perfusion index (PI) was elevated more than 5 folds; the temperature of hands and feet increased more than 3 ℃. Then, the patients received 3 mL and 5 mL anhydrous alcohol (containing iohexol), respectively, at thoracic and lumbar puncture points for CT scanning and three-dimensional reconstruction of the physic liquor distribution. Results CT could precisely guide the puncture needle to reach the target in these 23 patients. As compared with those before medication, the finger and toe tips perfusion indexes and temperatures of palmar and plantar surfaces at 5 min after injection of local anesthetics and 5 min after anhydrous alcohol were significantly increased (P<0.05); significant differences of them were noted between injections of local anesthetics and anhydrous alcohol (8.03±1.44 vs. 4.94±1.65, 33.35±1.79 vs. 32.94±1.54, P<0.05). One year after follow up, the rate of excellent and good therapeutic effects was 86.96% (n=21); and 1-year recurrence rate was 13.04% (n=3) without any complications. Conclusion CT guided thoracic combined with lumbar sympathetic nerve block technique is effective in treating palmar and plantar hyperhidrosis. Key words: Autonomic nerve; Thoracic sympathetic nerve; Lumbar sympathetic nerve; CT guided puncture; Hyperhidrosis