Management of Acute Gouty Arthritis-Reply

In Reply.— A review of the references cited by Dr Fox suggests that induction of a sympathectomy of the foot involves, in essence, performing a posterior tibial nerve block. To our knowledge, there are no controlled studies showing that this procedure shortens the normal course of a gouty attack. A posterior tibial nerve block may well be beneficial for temporary pain relief when (1) gouty arthritis is limited to the foot and (2) the administration of colchicine or a nonsteroidal anti-inflammatory drug is contraindicated. Care must be taken to avoid hitting the posterior tibial nerve, which might result in a traumatic neuritis. In addition, one must be careful to avoid intravascular injection of the posterior tibial artery (a landmark for this procedure). We do not think that this technique can be easily duplicated by physicians without previous experience in performing nerve blocks.