Dose-response relationship of anhydrous alcohol for thoracic sympathetic block in treating primary palmar hyperhidrosis

Abstract

Objective To determine the dose-response relationship of anhydrous alcohol for thoracic sympathetic block in treating primary palmar hyperhidrosis. Methods Two hundred patients with primary palmar hyperhidrosis, aged 18-33 yr, grade of palmar sweating 3 or 4, scheduled for elective surgery under thoracic sympathetic block, were divided into 5 different mixture of anhydrous alcohol and iohexol(iohexol∶anhydrous alcohol=1∶5)groups(n=40 each)using a random number table.Under CT guidance, thoracic intervertebral puncture was performed between T3 and T4 until the needle tip reached the spot around T4 and above capitis costae.The mixture of anhydrous alcohol 1.0 ml(group R1), 1.5 ml(group R2), 2.0 ml(group R3), 2.5 ml(group R4)and 3.0 ml(group R5)and iohexol was injected into the thoracic sympathetic ganglia on both sides.Effective block was defined as the rise in the palm temperature of both hands more than 3 ℃ and sweating completely disappeared at 10 min after thoracic sympathetic block was performed with anhydrous alcohol.The median effective dose(ED50), ED95 and 95% confidence interval(CI)of anhydrous alcohol for thoracic sympathetic block in treating primary palmar hyperhidrosis were calculated by probit analysis. Results The ED50(95% CI)of anhydrous alcohol for thoracic sympathetic block in treating primary palmar hyperhidrosis was 1.882(1.564-2.201)ml, and the ED95(95% CI)was 2.806(2.420-3.812)ml. Conclusion The ED50 and ED95 of anhydrous alcohol for thoracic sympathetic block in treating primary palmar hyperhidrosis are 1.882 and 2.806 ml, respectively. Key words: Ethanol; Autonomic nerve block; Ganglia, sympathetic; Dose-response relationship, drug; Hyperhidrosis