The Role of Sympathetic Nerve Block in Predicting Compensatory Hyperhidrosis before Thoracoscopic Sympathectomy

Abstract

Background: primary hyperhidrosis is a condition characterized by excessive sweating beyond physiological needs, Dissatisfaction among patients after sympathectomy for primary hyperhidrosis is primarily due to compensatory hyperhidrosis. This work aimed to evaluate efficacy of CT guided Sympathetic nerve block in predicting compensatory hyperhidrosis before doing sympathectomy.Subjects and methods: We performed this randomized clinical trial upon 36 patients who complained of signs and symptoms of primary hyperhidrosis were indicated for sympathectomy. All 36 patients underwent CT guided temporary local sympathetic block at level of T2, T3, analysis of cases was done for who were managed with permanent thoracoscopic sympathectomy regarding occurrence and grade of compensatory hyperhidrosis after block and after surgery.Results: For patients with absent compensatory hyperhidrosis in Ct guided Sympatheticnerveblock, 42.86% developed compensatory hyperhidrosis after surgery, the sensitivity and specificity were recorded at 33.33% and 40%, respectively . In mild grade of compensatory hyperhidrosis was present, 21.43% of cases continued to experience mild compensatory hyperhidrosis after surgery, the sensitivity and specificity for this grade were 25% and 80%, For moderate grade of compensatory hyperhidrosis, 21.43% progressed to experience moderate compensatory hyperhidrosis after surgery, for severe grade of compensatory hyperhidrosis cases showed a statistically significant increase to 14.29% after surgery, with a significant p-value of 0.0385*.specificity for this grade was notably high at 85.71%, and NPV was 100%, resulting in an accuracy of 85.71%.Conclusion: The significant association between severity of compensatory hyperhidrosis after block and development of severe cases after surgery highlights potential utility of this preoperative assessment