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Differential effects of surgical sympathetic block on sudomotor and vasoconstrictor function

From the Department of Surgery (Drs. Schick, Fronek, Held, and Hohenberger), University of Erlangen–Nürnberg; Department of Neurology (Dr. Birklein), University of Mainz; and Department of Anesthesiology (Dr. Schmelz), University of Heidelberg, Mannheim, Germany.

Address correspondence and reprint requests to Dr. M. Schmelz, Department of Anesthesiology and Intensive Care Medicine, Faculty of Clinical Medicine–Mannheim, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 61087 Mannheim, Germany; e-mail: martin.schmelz{at}anaes.ma.uni-heidelberg.de

Objective: To assess the effects of a surgical block of the sympathetic chain at the T2 level on vasoconstriction and palmar sweating in patients with palmar hyperhidrosis.

Methods: In a prospective study, sympathetic vasoconstriction was measured by laser–Doppler imaging and by computer-assisted infrared thermography (rewarming kinetics following immersion of both hands in ice water [4 °C, 30 seconds]) in 61 patients with hyperhidrosis preoperatively and 2 days and 3 months postoperatively. In addition, palmar sweating preoperatively and 3 months postoperatively was assessed by quantitative sudometry.

Results: Before surgery, rewarming kinetics was significantly slower in the patients (n = 61) than in the healthy control subjects (n = 28). Two days after the block, baseline skin temperature increased by about 5 °C, and rewarming was massively accelerated in each of the patients. Three months postoperatively, rewarming kinetics was still accelerated in 36 hands, was unchanged from the preoperative condition in 42, and had worsened in 12. These changes were accompanied by parallel alterations of laser–Doppler flux. However, palmar sweating was massively reduced in all but one patient, irrespective of the different rewarming kinetics.

Conclusions: T2 sympathectomy leads to long-lasting inhibition of palmar sweating, which does not correlate to loss of vasoconstriction. Recurrent and enhanced vasoconstrictor function 3 months following endoscopic sympathetic block has major implications for its use to treat enhanced vasoconstriction.

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