Thoracic Endoscopic Sympatheitc Ganglion Cauterization on Reflex Sympathetic Dystrophy under One-Lung Ventilation

Lee, Sang Hun

Abstract

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 severe 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 hospitals orthopaedic department. Our diagnosis, confirmed by thermography, revealed reflex sympathetic dystrophy. Patient 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 4th intercostal space along mid axillary line and midclavicular line. Negative pressure suction on ipsilateral lung and CO2 insufflation under 10mmHg was applied to reduce lung size. Cauterization on thoracic sympathetic chain at T3 level was done under endoscoic guide. 24 Fr. chesttube was inserted. Patient's symptoms cleared and he was satisfied with the results of this treatment.