Guanethidine Blocks

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I have had seven intravenous Guanethidine blocks in the last couple of months so I may be able to give you a little info although it is totally subjective. I have RSD in my lower left leg, foot and ankle. In my case a tourniquet was placed around my thigh to cut the blood supply off to my leg and the drugs were inserted through a needle in my foot. The tourniquet in itself can be quite unbearable but the insertion of the needles was quite horrendous. I can't think why they would want to put needles into an already hypersensitive area and unfortunately I had to have this done with no anaesthetic - it wasn't pleasant to say the least. The drugs themselves cause a burning sensation as they get into the bloodstream along with other weird sensations; you can get raised itchy blotches (but these disappear shortly) and bad blood shot eyes accompanied with a bad headache.

They attempted the second one, again with no anaesthetic, but had to abandon it as my foot was so cold due to constricted blood vessels and they couldn't get the needles into my veins without causing me huge amounts of stress. All subsequent ones were carried out in day surgery and done under a general anaesthetic and were so much easier. The thing that I wasn't told when I had them was that initially they can cause more swelling and hence more pain, so several days on I thought they had totally messed up my foot but it did eventually subside.

I'm sorry I'm making this sound awful, but I have had a small amount of improvement after them, mainly in the swelling; this went down quite substantially after the 7th but has unfortunately returned with the cold weather. My pain specialist said that he would do no more of these as I am still unable to walk and have had no major improvements. I am now booked in for a lumbar sympathectomy in March. As I said, this is only my experience, so please don't be put off. I have a friend who had a condition that wasn't diagnosed as RSD ten years ago but sounds identical to mine, and after being wheelchair bound for some time walked after her 2nd block! Please don't let me dishearten you. Although if you do decide to proceed with blocks I would insist on having them under a general anaesthetic if possible as this makes the whole procedure a lot easier and therefore less painful.

I was also told that any benefits would be short lived - several hours at most. What they hope is that in this amount of time the pain signals/nerve impulses would reverse themselves and after several blocks, resolve the situation. RSD is so individual so the things that don't work for one may be miraculous for another and vice versa. Katy - Buckinghamshire, UK

Response to Katy
I am sorry to hear you had such a bad experience with Guanethidine blocks, the next one I have will be on 16th January, and will be number 51. I will admit that they are not always lasting as long or sometimes as well as they first did, but any relief no matter how short lasting is better than none. Your pain specialist must be a little barbaric to say the least as mine has always done them under a General Anaesthetic, she was the one that told be it would be to painful to bear otherwise, due to the RSD. I agree that under no circumstances should one of these block be carried out by a GP. Firstly it is a sterile procedure and secondly it needs to be done by someone who has been trained on this treatment - otherwise so much could be done.

I have been having this treatment over a period of 8 years and normally have about 7 a year. You need to make sure that there is no manipulation whilst you are under as this could also make it worse (see Dr Hooshmond's site, a pain clinic in Florida - you can get into it through the RSD Alert links page). Kate - Berkshire, UK

I've got RSD/CRPS in my right foot and had a series of about 8 Guanethidine Nerve Blocks in the foot several years ago. I was put to sleep for the procedure and - Nanette is right - they put a cuff around top of leg, put a cannula* into the main vein in foot and inject the drug... I was given Medazalm and Alfentinil in theatre to put me asleep and to control the pain. I found that the Guanethidine Blocks made my foot turn very hot (instead of stone cold) and even more swollen. Pain wise they didn't do anything for me. Mel -UK
* Cannula = a tube inserted into the body to withdraw or deliver fluid

I don't know if this will help or hinder people going for treatment. In 1993 I was diagnosed with RSD in my left arm/hand. I underwent a total of 54 Stellate Ganglion Blocks that helped with pain relief on a temporary basis (it would last 3-5 days), these blocks were done on a once a week basis. At around block 27 it was decided to try a series of 4 Guanethidine Blocks. This very uncomfortable procedure was done on an out-patient/day-surgery basis. The doctor tied off my arm from hand to above the elbow, which I had to keep elevated for 25 minutes before the G.B was done. I was not given any medications for pain or sedatives to help cope with this procedure which was extremely painful; although when the tourniquet was taken off alot of the acute pain subsided. I did not find this procedure to be of any help at all, but I did do the whole series of 4 just in case. That same year I underwent a Thoracic Sympathectomy which caused numerous painful problems some transient and some permanent and did absolutely nothing for any pain relief for the RSD. After 50 Stellite Ganglion Blocks I started developing very severe headaches when I had the procedure and after doing 4 more with the same result the Doctor decided to stop the Blocks and I was left with an immense amount of pain. I have now developed RSD in my Right Arm and have started undergoing another series of Stellite Ganglion Blocks, so far I have only had 4. I am prepared to have these as long as they give me some relief but will not undergo another Thoracic Sympathectomy. Has anyone out there got any knowledge of how many, or how long I can have the Stellite Ganglion Blocks? I would love to get some information back from anyone about this.
In conclusion, in MY EXPERIENCE, I would not have another Guanethidine Block done or a Thoracic Sympathectomy. For the amount of pain I went through and the amount of damage done by the surgery I do not find them optimum procedures. Ginnie - Canada

I am a Forensic Biochemist. From reading my edition of Doctor's Guide I know that they are finding Guanethidine (a drug used for blocks) is not working as well as they first thought it would, particularly in men, but was almost as bad in women under the age of 60. Bupivicaine seems to be one of the more useful drugs used for blocks, as well as in morphine pumps. Bupivicaine seems to be the drug of choice now, as is the super Dilaudid as well as the super morphine. The one problem however in its use in pumps is that it completely obliterates pain, and if you accidentally cut your foot, or are not constantly vigil about your feet it can lead to infection. Do remind folks that when they have blocks they should have them about a week apart, series of 3, then try to go as long as possible, and I'm talking 6 months to a year, before they have another series of blocks, they seem to work better that way. Also, the body doesn't become so used to them. Nanette Sheckler, PhD - USA