PARAVERTEBRAL ALCOHOL BLOCK OF LUMBAR SYMPATHETIC NERVES: EVALUATION BY SWEATING TESTS IN THREE HUNDRED FIFTY-ONE PATIENTS

Paravertebral injection of alcohol for the purpose of blocking lumbar sympathetic ganglions was carried out in 351 patients with peripheral occlusive vascular disease (97% of cases), popliteal aneurysms, causalgia, or hyperhidrosis. The total number of injections was 454, since some were bilateral and others were repeated. Premedication and local anesthesia were used to facilitate injection, and 4 cc. of absolute ethyl alcohol was given in each case. The extent of the resulting sympathetic blocking was determined by a sweating test. This consisted of painting an alcoholic solution of cobaltous chloride on the dry skin and noting the change from deep blue to bright pink in those areas where sweating could still be induced. Adequate sympathetic blocking was achieved in 65 % of all treated patients. Side-effects included neuralgia, which occurred in 10 patients and which was controlled by physical therapy. The value of alcohol block in cases of intermittent claudication was not demonstrated, but other evidence of improved circulation was obtained. This procedure is a substitute for lumbar sympathectomy and has given symptomatic relief in cases where operation was refused or contraindications for operation existed.