Effects of transvenous regional guanethidine block in the treatment of critical finger ischemia

The objective of this study was to determine the effects of transvenous reg ional guanethidine block in the treatment of patients with critical finger ischemia. Twenty-seven patients (17 collagen vascular disease, four thrombo angiitis obliterans, three embolism, three atherothrombosis) presenting wit h ischemic rest pain and/or ulcerations of the fingers received a single bl ock with 5 mg guanethidine injected in 60 mL into the clinically more affec ted hand under 30 minutes of arterial arrest. Marked hyperemia was induced in the treated upper limb, increases (p < 0.01) in finger blood flow, finge r skin temperature, and laser Doppler flux were higher and longer lasting t han in forearm blood flow, persisting for a whole month. Effects in patient s with ischemic finger ulcers were less pronounced than in those without, y et statistically significant increases of all evaluated parameters were obs erved in these patients too. No effects were seen in the contralateral untr eated upper limb or in systemic blood pressure. Subjective symptoms (reduct ion of rest pain, numbness, vasospastic attacks) were improved in 25/27 (92 .6%) patients, ischemic rest pain disappeared in 20/27 (74.1%), and complet e healing of finger tip ulcerations within 1 month was achieved in 10/12 (8 3.3%) affected patients. No side effects were observed. This described meth od combines good clinical efficacy with lack of undesirable side effects an d can be repeated easily. Therefore, this technique is recommended for broa der clinical use.