Letter to the Editor
Response to Dr. Paraskevas’ Comments
To the Editor:
Dr. Paraskevas and colleagues1,2 present an interesting and important alternative modality for the treatment of Complex Regional Pain Syndrome (CRPS) with the utilization of intravenous (IV) guanethidine. Guanethidine is available for IV use in other countries but is not commercially available in the United States. Guanethidine exerts its effects at the postganglionic terminals of adrenergic neurons. Sympathetic sprouting can occur in the dorsal root ganglia of patients with CRPS. We hypothesized in our article that stellate ganglion blockade should be done before significant sympathetic sprouting occurs. We further hypothesize that the use of fluoroscopy when doing stellate ganglion blockade improves safety and efficacy as the spread of the injectate can be controlled and detection of intravascular needle tip placement can be readily ascertained. However, as we reported, a significant number of patients experience no pain relief with stellate ganglion blockade. A number of patients with CRPS ultimately require placement of a spinal dorsal column stimulator for attempted pain control.3 The use of IV guanethidine with lidocaine as proposed by Dr. Paraskevas and colleagues is an excellent alternative and/or adjunct therapy to current accepted therapies and should prove to be cost-effective.
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