Peripheral sympathetic block with therapeutic local anesthesia for the manage-ment of upper limb digital ischemia.

BACKGROUND: Thromboangiitis obliterans (TAO) is a non-arteriosclerotic segmental inflammatory occlusive vasculitis typically in the upper and lower extremities affecting small- and medium-sized arteries and veins. We present the treatment protocol for TAO involving the use of peripheral sympathetic block through an axillary catheter. CASE REPORT: An unconscious 56-year-old female patient was transferred to the emergency service, intubated, and mechanically ventilated. The patient was provisionally diagnosed with hypertensive intracranial hematoma and admitted to the intensive care unit. Invasive arterial pressure monitoring was performed through the left radial artery cannula. Four days later, upon the observation of symptoms of a circulatory disorder in the fingers distal of the left and right hands, the cannula was removed from the left radial artery, and another was placed in the left dorsalis pedis artery. At the same time, an 18 Gauge catheter was placed in the axillary perineural sheath bilaterally, and a total of 10 ml lidocaine 0.5 % (5 ml for each side) was injected six times a day. During each injection, the temperature was measured using a surface probe on the distal of the fingers with poor perfusion and another area of the same hand with good perfusion. Lidocaine treatment protocol through the axillary perineural catheter was applied for 15 days for the right hand and 18 days for the left hand. As the treatment proceeded, a significant increase was observed in the results of the temperature measurements on the fingers with poor perfusion. 
Conclusion: We believe that a peripheral sympathetic block as we report herein could be considered as an alternative in the treatment of TAO. HIPPOKRATIA 2018, 22(3): 141-144. Copyright 2018, Hippokratio General Hospital of Thessaloniki.