Comparison of lower extremity cutaneous temperature changes in patients receiving lumbar sympathetic ganglion blocks versus epidural anesthesia

Study Objective: To investigate if paravertebral lumbar sympathetic ganglio n block and lumbar epidural anesthesia result in comparable cutaneous tempe rature changes in the lower extremity. Design: Nonrandomized comparison study. Setting: Operating rooms and pain clinic procedure rooms in a tertiary care hospital. Patients and Interventions: 18 patients undergoing lumbar sympathetic gangl ion blocks for the diagnosis and/or treatment of chronic pain, and 13 patie nts undergoing lumbar epidural anesthesia for radical prostatectomy. Measurements: Cutaneous temperatures were measured over the great toe, calf , and thigh in all patients. Mean maximum temperature (Tmax), rate of chang e of skin temperature (from 5% to 95% of maximum temperature change), and m ean time to 1 degreesC increase, and 50% and 95% of maximum temperature cha nge for each group were compared. Temperature changes for the epidural and lumbar sympathetic block patients were compared. Main Results: Epidural and lumbar sympathetic block resulted in similar Tma x (34.1 +/- 0.2 and 33.8 +/- 0.9 degreesC, respectively, mean +/- SEM; p = 0.18) and rate of temperature change )0.64 +/- 0.09 and 0.49 +/- 0.07 degre esC/min; p =0.2) in great toe. The onset of cutaneous temperature change af ter lumbar sympathetic block was slower than after epidural anesthesia (1 d egreesC increase: 17 and 11 min, respectively, 50% of Tmax: 25 and 17 min, respectively, and 95% of Tmax: 40 and 31 min, respectively; p < 0.05 for ea ch). Conclusions: The similar rate and magnitude of cutaneous temperature change in the distal lower extremity suggests the degree of sympathetic blockade is similar with lumbar sympathetic blockade and epidural anesthesia. Either technique should provide adequate sympathectomy for treating sympathetical ly maintained pain once the diagnosis has been confirmed using selective sy mpathetic blockade. (C) 2000 Elsevier Science Inc.