INTRAVENOUS GUANETHIDINE IN PATIENTS WITH REFLEX SYMPATHETIC DYSTROPHY

Background: Intravenous regional guanethidine Bier block (IVRGBB) has been used predominantly in Europe for treating reflex sympathetic dyst rophy (RSD). Our experience in the United States, where its use has be en limited, is reported.Methods: Fifty-five patients received IVRGBB f or RSD. Upper extremities received 20 mg (10 mg/ml) of guanethidine in 30-50 ml of 0.5% lidocaine; lower extremities received 40 mg in 40-75 ml of lidocaine (volume adjusted for size, weight, or prior adverse e ffect). Pain severity (mild, moderate, severe, excruciating) was obtai ned pretreatment. Pain severity and a global clinical assessment (GCA) (resolved, improved, no change, worse) were obtained following each t reatment. The final GCA was analyzed vs: pretreatment score; age; sex; pain duration; number of treatments; and precipitating event. Adverse effects were documented. Results: Of 55 enrolled patients, 2 were los t to follow-up, and 2 returned 1 and 4 years later for repeat treatmen t. Therefore, 53 patients were evaluated for 55 treatments. Age: 38.2 +/- 14.8 (SD) (range 10-77) years. Sex: 11 males, 44 females. Average pain duration: 2.0 +/- 1.7 years (3 days - 7 years). Final assessment occurred at 3.88 +/- 5.21 months (6 days - 22/3 years). Effect on pain resolution-9.1%; improved-14.5%; no change-61.8%; worsening-14.5%. No significant relationship was found between GCA and the factors evalua ted. There was a significant positive linear association between pretr eatment pain and post treatment GCA (P=0.032). Fifty-six adverse effec ts occurred in 19 (34.5%) patients (nausea, vomiting, orthostatic hypo tension, dizziness, diarrhea, weakness). Conclusions: IVRGBB does not provide long-term pain relief and is associated with adverse effects i n over 1/3 of patients. (C) Acta Anaesthesiologica Scandinavica 40 (19 96)