Contraindications. Prior contralateral sympathectomy, significant cardiovascular disease, or autonomic nervous system insufficiency.
Post-operative course. Mild-moderate post-operative pain, usually lasting less than 2 weeks.
Results. Sympathetic blocks and sympathectomies may provide significant relief in 60% of patients who undergo them (19-23). The mechanism on which this relief is based is open to question. There may be a significant placebo effect influencing the response to sympathetic blocks (18, 19). Mean time to pain recurrence following sympathectomy is six months (23).
Benefits. Several months of sympatholysis from a safe, repeatable, outpatient procedure, which doesn't cause local fibrosis, rendering subsequent retroperitoneal surgery difficult.
Risks. There are various risks associated with sympathectomy. These risks are minimized through the use of CT imaging, careful needle placement, and utilizing RF instead of chemical neurolysis.
The major risks of radiologically guided sympathectomies include pnemothorax, inadvertent damage to the genitofemoral nerve in the lumbar area, and inadvertent root trauma. Transient hypotension may follow sympathetic blocks and sympathectomies. Bilateral cervical sympathectomies should be avoided because of the destruction of cardioaccelerator tone. Bilateral lumbar sympathectomies carry a risk of impotence.
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