Blood Flow in the Hand and Forearm After Paravertebral Block of the Sympathetic Ganglia. Evidence Against Sympathetic Vasodilator Nerves in the Extremities of Man

Warren, James V.; Walter, C.; Romano, John; Stead, Eugene A.

doi:10.1172/jci101343

Cited by 39 publications

(20 citation statements)

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“…Local nerve block then caused the anesthetized area to pale, cool, and cease sweating. However, as pointed out by Warren, et al (6), the authors are unable to account for the difference between the effect of sympathectomy which increases forearm flow and the effect of local nerve block which, they concluded, under certain conditions, diminishes it. It should also be added that these investigators added epinephrine to the procaine with which the local nerve blocks were performed.…”

Section: Discussionmentioning

confidence: 93%

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mentioning

confidence: 99%

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Vasodilator Fibers in the Human Skin

Sarnoff¹,

Simeone²

1947

J. Clin. Invest.

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Reports on vasodilator fibers in the human skin have not been in general agreement concerning either their existence or their relative functional significance (1)(2)(3)(4)(5)(6). In a recent review on sympathetic surgery (7), the interruption of vasodilator fibers was cited as a possible cause for the limited benefit that occurs after sympathectomy for certain types of peripheral vascular disease. It seemed worthwhile, therefore, to reexamine the available evidence and approach the problem of vasodilator activity from points of view other than those previously described.Lewis and Pickering (4) suggested that heating the body produces maximal vasodilatation in the skin of the extremities by inhibiting vasoconstrictor impulses and also by stimulating additional active dilatation by vasodilator impulses. If this is true, local nerve block performed during pronounced heating of the body or of the other extremities should interrupt these vasodilator impulses, exclude active vasodilatation, and produce a slight but definite fall of skin temperature. The magnitude of the reduction should be proportional to the postulated activity of the vasodilator mechanism at the time of the block. METHODPatients on the surgical wards of the Massachusetts General Hospital were studied. Before beginning the experiment, the patient was placed in the cold room and covered only by a loin cloth. Skin temperatures were determined by means of 8 iron-constantan thermocouples which led to an electronic, nongalvanometric, continuous balance potentiometer.' This recorder registered in rotation every 30 seconds so that each thermocouple registered every 4 minutes.When skin temperatures were determined on the band, the palmar surface of the distal phalanx of the second and fifth digits were used. The plantar surface of the distal phalanges of the toes and a point on the lateral aspect of the dorsum of the foot were used in obtaining skin temperatures of the lower extremity. The shielded wire proximal to the naked thermocouple was taped to the appropriate site at least 2.5 cm. away from the point of 'Brown Instrument Co., Boston, Mass. actual determination so that there was no interference with heat loss at the point of determination.Rectal temperatures, when obtained, were recorded by means of a resistance bulb and potentiometer recording on a circular chart readable to 0.020 centigrade.2 The values at 5-minute intervals were charted. Procaine or metycaine hydrochloride was used for the local blocks. The ulnar nerve was blocked at the elbow. Ankle block was achieved by combining the conventional posterior tibial block with complete ring block at the ankle. The spinal block and the ring block of the toe were performed in the conventional fashion. Care was taken to make certain that epinephrine was not added to the anesthetic agent. In those patients in whom a sympathectomy had been done, the blocks were always performed on the intact side.Indirect vasodilatation in the hands was induced by placing the legs in warm water at 43-44' C. up to the knee...

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Section: Discussionmentioning

confidence: 93%

“…

…”

mentioning

confidence: 99%

Vasodilator Fibers in the Human Skin

Sarnoff¹,

Simeone²

1947

J. Clin. Invest.

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“…In studies of vasomotor control in the human skin, the hand has been used more frequently than other regions of the body, not only on account of its accessibility but also because in it the ratio of skin to other tissues is particularly high; and it has been generally assumed that the vasoconstrictor mechanism so clearly demonstrated in the skin of the hand (Lewis & Pickering, 1931;Warren, Walter, Romano & Stead, 1942;Sarnoff & Simeone, 1947;Arnott & Macfie, 1948;Gaskell, 1956) is the means whereby the blood flow is controlled in the skin elsewhere in the body. Grant & Holling (1938), who used the skin temperature of the forearm as a measure of the changes in cutaneous blood flow, showed however that blocking the cutaneous nerves by local anaesthesia did not cause either flushing or warming of the skin, and that a similar cutaneous nerve block performed during body heating produced pallor and cooling in the anaesthetized area.…”

Section: Discussionmentioning

confidence: 99%

Vasomotor control of the cutaneous blood vessels in the human forearm

Edholm¹,

Fox²,

MacPherson³

1957

The Journal of Physiology

136

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Considerable evidence has recently accumulated to show that the increased blood flow in the forearm elicited by body heating is confined to the skin vessels (Barcroft, Bock, Hensel & Kitchin, 1955;Roddie, Shepherd & Whelan, 1956), so that the usual methods of venousocclusion plethysmography can be used to study the changes which occur in the blood flow of the skin of the forearm when the body is heated. In this paper results are presented of experiments using these methods which indicate that the blood flow in the forearm skin is controlled by a vasodilator mechanism, in contrast to the vasoconstrictor release mechanism found in the skin of the fingers and hand. They provide, by the use of a direct method for measuring blood flow, confirmation of the conclusions arrived at by Grant & Rolling (1938) based on measurements of skin temperature. METHODSSubject8. Twelve adult male subjects were used, but the majority of the experiments were performed on three subjects whose ages ranged from 33 to 47 years.Blood-flow meawurements. The method used followed closely that described by Edholm et al. (1956). The blood flow in both forearms, supported at the level of the right atrium, was measured simultaneously by means of two water-fllled venous-occlusion plethysmographs. The subject reclined comfortably in a bath. The bath water could be controlled at any desired temperature. Except where otherwise stated, the temperature of the plethysmograph was maintained at 340 C and that of the room at 26°-270 C. Ten in-flow traces, each of 5 sec duration with 10 sec intervals, were automatically recorded in 150 sec, and the subject then rested for 150 sec; the recording was only interrupted for manipulative procedures. Each value shown in the graphs is the mean of the last eight of each ten in-flow traces.Nerve block. The cutaneous nerve supply to the forearm was blocked by injecting approximately 10 ml. of a 2% solution of lignocaine (containing 1: 67,000 adrenaline hydrochloride) in a continuous subcutaneous ring about 3-4 cm distal to the tip of the olecranon. If anaesthesia of the forearm was then found to be incomplete, the unanaesthetized nerves were located by faradic stimulation and separately injected. Anaesthesia was considered to be complete when the

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“…Vasoconstrictor responses are determined by a-adrenotropic receptor activity (Moran, 1970) whilst the vasodilator responses are of cholinergic (Brody & Shaffer, 1970) and 3-adrenoceptor origin (Harrison & Turner, 1969). Fox, Goldsmith & Kidd (1962) have shown that the vasodilator responses of the skin of the neck and upper chest are the result of active vasodilatation whereas others (Warren, Walter, Romano & Stead, 1942;Gaskell, 1956) have demonstrated that vasodilatation of the skin of the hand is the result of release of vasoconstrictor tone. Circulation in skeletal muscle is controlled by several mechanisms (Ross, 1971); in general, however, vasoconstriction is mediated by a-adrenotropic activity whilst vasodilatation is determined by cholinergic and 1B-adrenotropic activity.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Indoramin on Peripheral Blood Flow

Royds

Lockhart²

1974

Brit J Clinical Pharma

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The effect of indoramin, a new hypotensive agent, on peripheral blood flows of six normal subjects was determined and compared to placebo in a double-blind, randomized study. 2 Indoramin (0.25 mg/kg), administered intravenously, resulted in an increased forearm muscle volume as measured by strain gauge plethysmography and an increase in the skin temperature of the hand but not to the skin of the chest. 3 It is concluded that these effects are the result of a-adrenoceptor blockade.

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Blood Flow in the Hand and Forearm After Paravertebral Block of the Sympathetic Ganglia. Evidence Against Sympathetic Vasodilator Nerves in the Extremities of Man

Cited by 39 publications

References 5 publications

Vasodilator Fibers in the Human Skin

Vasodilator Fibers in the Human Skin

Vasomotor control of the cutaneous blood vessels in the human forearm

The Effect of Indoramin on Peripheral Blood Flow

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