REGIONAL SYMPATHETIC GUANETHIDINE BLOCKS FOR THE TREATMENT OF REFLEX SYMPATHETIC DYSTROPHY OF THE LIMBS

Four hundred and ten regional sympathetic guanethidine blocks were performed to treat 103 episodes of reflex sympathetic dystrophy in 98 patients. In 99 episodes, other previous treatments had failed or provided inadequate relief; in the four remaining episodes, guanethidine was used as first line treatment. Mean number of blocks per episode was 4.27 +/- 1.82. Success rate was 69.9%, with no statistically significant differences between upper limbs (27 episodes) and lower limbs (76 episodes) and no significant influence, of age, sex, duration of the disease, or nature of previous treatments. In patients with psychologic disorders, success rate was 55.5 %, versus 77.6 % in the other patients (p < 0,02). Among the 31 failures (30.1 %) only 20 (19.4 %) were true failures since treatment had to discontinued in the remaining 11 patients (11/103) because of adverse effects. Tolerance was perfect or satisfactory in 86.4 % of episodes and poor (discontinuation of therapy) in 13.6 % of episodes (i.e. 4.4 % of the 410 blocks). Risk of intolerance increases significantly with age. Effectiveness of regional sympathetic guanethidine blocks in reflex sympathetic dystrophy was thus very satisfactory and offered acceptable tolerance. This procedure is a reasonable alternative when other treatments, mainly calcitonin, prove inadequate.