A Review of Insertion Site for Lumbar Sympathetic Ganglion Block / 대한마취과학회지

ABSTRACT

BACKGROUND: Lumbar sympathetic ganglion block (LSGB) is one of the most frequently performed blocks in the field of interventional pain management. However, several complications can be expected if pain clinicians do not have a through understanding of radiological anatomy and current technique for locating block, landmarks are poor. Therefore, we devised a simple, safe, and patient tolerable block technique. METHODS: We selected patients scheduled for a LSGB with a body mass index of less than 25 kg/m2. After prone positioning, C-arm projection was adjusted obliquely until the tip of the L3 transverse process met the lateral margin of the corresponding vertebral body. Maintaining this angle, the skin entry point was determined at the lower one-third of the lateral margin of the vertebral body. We measured the distance from the mid-point of the spinous process to the skin entry point. A curved block needle was advanced using the tunnel vision technique, until the needle tip touched the lateral margin of the vertebral body. We also measured the position of the needle tip relative to the vertebral body in the lateral projection of the C-arm (lateral width percentage). Thereafter, the needle was slid along the lateral margin of the vertebral body to the anterior margin. RESULTS: The distance from the mid-point of the spinous process to the skin entry point was 6.5 +/- 1.0 cm. The angle of the C-arm projection was 22.0 +/- 3.8o. The depth from the skin entry point to the needle tip when touching the lateral margin of the vertebral body in the oblique projection of the C-arm was 8.5 +/- 0.9 cm. The lateral width percentage from the posterior margin of vertebral body was 49.0 +/- 7.0% and the entire depth of the curved needle from the skin entry point to the anterior margin of the vertebral body was 10.4 +/- 1.0 cm. CONCLUSIONS: This simple tunnel vision technique using a curved needle and an oblique C-arm projection is safe, simple and patient tolerable. In addition, it reduces block time and avoids repeated needle insertions. The tip of the L3 transverse process and the lateral margin of the corresponding vertebral body were found to be useful bony landmarks for the block. We believe that the provided depths and lateral width percentages may be useful for block in Koreans.