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Bilateral pain relief after unilateral thoracic percutaneous sympathectomy

[Contrôle bilatéral de la douleur après une sympathectomie thoracique percutanée]

From the Department of Anesthesia, Sunnybrook & Women’s College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Michael Gofeld, Department of Anesthesia, Sunnybrook & Women’s College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Phone: 416-480-4864; Fax: 416-480-6039; E-mail: mgofeld{at}rogers.com

Purpose: To present a case of unexpected bilateral pain relief following unilateral thoracic percutaneous sympathectomy.

Clinical findings: We present a case report where severe ischemic pain due to paraneoplastic Raynaud’s syndrome with distal gangrene was successfully treated by means of percutaneous thoracic sympathectomy. A unilateral T2, T3 radiofrequency sympathectomy combined with small volume phenol injection resulted in unexpected bilateral pain relief.

Conclusion: Our observations from this case report suggest a possible crossover of sympathetic innervation at the cervical and thoracic levels. Percutanenous thoracic radiofrequency sympathectomy is a feasible option for the treatment of refractory ischemic upper limb pain.