Prevention of pneumothorax in CT-guided thoracic sympathetic nerve block

Abstract

Objective To explore the measures for prevention of pneumothorax in CT-guided thoracic sympathetic block. Methods The clinical data of 769 patients with hyperhidrosis or Raynaud syndrome treated with CT-guided chemical destructive block of thoracic sympathetic nerve chain in Jiaxing First Hospital from January 2010 to December 2017 were retrospective analyzed. The CT-guided thoracic sympathetic nerve block puncture was performed with a special blunt needle outside the wall pleura above the caput costae following the principle of safe distance and advance only. After exclusion of pneumothorax by CT scan, 2.5 ml of absolute ethanol mixed with 30% iohexol 0.25 ml was injected on both sides of thoracic sympathetic nerve chain. Results The punctures were successfully performed in all 769 patients (1 538 nerve chain segments) and no pneumothorax occurred. After treatment with absolute ethanol injection, Horner syndrome occurred in 31 patients, which disappeared after injecting saline into the stellate ganglion; and intercostal neuralgia occurred in 188 patients after surgery, which was healed in 1 to 3 months. Conclusion It is suggested that pneumothorax can be avoided through CT guidance, using appropriate needles and puncture techniques during the procedure of thoracic sympathetic nerve chain block. Key words: Sympathectomy, chemical; Ganglia, sympathetic, thoracic; Intraoperative complications; Pneumothorax