A brief report on a technical description of ultrasound-guided lumbar sympathetic block

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.

Lumbar Sympathetic Block for Spinal Cord Infarction Patient: A case report / 대한통증학회지

This report describes a case of spinal cord infarction after acupuncture. The patient was treated with lumbar sympathetic block with using C-arm fluoroscopy. A 66-year-old patient with chronic low back pain and radiating pain in the lower limb was treated with acupuncture and he suddenly had a loss of motor and sensory of both lower extremities. His clinical presentaion and neuroimaging studies were consistent with spinal cord infarction. He was treated with steroid megatherapy and he showed improved in motor function, but there was no pain relief despite the phamacological treatments that were combined with caudal blockade. He visited to our hospital and had lumbar sympathetic blockade performed. The pain was relieved without any related complication after 1 month (VAS 9/10 --> 2/10), and he has been content with the results of treatment.

Neural Blockade

The sympathetic nervous system has been implicated in the maintenance of numerous pain syndromes. Interruption of sympathetic pathways has been widely applied to relieve pain. Neurolytic sympathetic block is often well tolerated, because numbness and motor weakness are uncommon and neuritis rarely develops. The classic targets for sympatholysis are the stellate or cervicothoracic ganglion for facial and upper extremity pain, celiac plexus for abdominal pin, and lumbar sympathetic chain for lower extremity pain. In addition, the thoracic ganglion is occasionally blocked for the treatment of hyperhidrosis and of pain emanating from the pleura and esophagus. The recognition of the clinical utility of cervical epidural nerve block in the management of head, face, neck, shoulder, and upper extremity pain has brought the technique into the mainstream of contemporary pain management practice. Lumbar epidural nerve block has great utility in the management of a variety of acute, chronic, and cancer-related pain syndromes. The nerve root sleeve is particularly accessible to precise local anesthetic blocks. Segmental information gained from such nerve root blocks can be helpful in sorting out confusing patterns of referred pain to the limbs. The pathway for insertion of spinal needles must be planned so as to avoid damaging neural structures. Spinal nerve roots are particularly delicate structures and do not take kindly to being impaled.

Chemical Lumbar Sympathetic Block: Comparison of One- Versus Two-needle Techniques / 대한마취과학회지

BACKGROUND: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. METHODS: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and third lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. RESULTS: The duration of anhidrosis was 12.2 2.6 months (mean SD) in the single-needle group versus 13.6 3.6 months (mean SD) in the two-needle group. CONCLUSIONS: As these results were not significantly different from those obtained in patients having a two-needle sympathectomy, blockade of the single-needle technique under C-arm fluoroscopy is considered to be effective for a neurolytic lumbar sympathectomy.

Chemical Lumbar Sympathetic Block: Comparison of One- Versus Two-needle Techniques / 대한마취과학회지

BACKGROUND: It was frequently noticed in the course of performing a two-needle sympathectomy, that satisfactory spread of contrast solution could be produced by injection through only one of the needles. This led to a closer examination of the merits of single-needle technique. METHODS: Forty patients were randomized into two groups. Patients in the single-needle group (n = 20) were injected at the second or third lumbar sympathetic ganglia, while patients in the two-needle group (n = 20) were injected at the second and third lumbar sympathetic ganglia. Lumbar sympathetic blocks were performed using 3 ml of alcohol and the spread of injectate was verified with C-arm fluoroscopy. The indicators of a successful sympathetic block are increasing skin temperature, decreasing pain, and anhidrosis in the distal extremity. RESULTS: The duration of anhidrosis was 12.2 2.6 months (mean SD) in the single-needle group versus 13.6 3.6 months (mean SD) in the two-needle group. CONCLUSIONS: As these results were not significantly different from those obtained in patients having a two-needle sympathectomy, blockade of the single-needle technique under C-arm fluoroscopy is considered to be effective for a neurolytic lumbar sympathectomy.

The Usefulness of Radioisotope Angiography in Management of Reflex Sympathetic Dystrophy Syndrome / 대한마취과학회지

Reflex sympathetic dystrophy syndrome is characterized by variable complex of the following symptoms, such as pain, tenderness, vasomotor instability, and trophic changes in distal extremities resulting from injury to either central or peripheral nervous tissue. We measured blood flow using radioisotope angiography with agent containing technecium-99m in one patient with reflex sympathetic dystrophy syndrome. Blood flow were significantly lower in affected side than normal side. After epidural block with 0.5% lidocaine and left lumbar sympathetic block with 100% alcohol, burning pain was disappeared and blood flow was increased to near or above in relation to the normal side. Radioisotope angiography is a noninvasive study and not so expensive. And we thought that radioisotope angiography may be a useful aid not only for diagnosis, but also for evaluating therapeu-tic response.