Shivam
Pain Management
Centre
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Lumbar Sympathetic Block

 

Anatomy

  • The lumbar part of the sympathetic chain lies on the antero-lateral border of the vertebral body .

Indications

  • Poor leg circulation, gangrene of the foot, arterial leg ulcers.
  • CRPS I, CRPS II, Post Herpetic Neuralgia, Phantom Limb Pain.
  • Hyperhydrosis (sweaty feet).

Contra-indications

  • Bleeding and infection risks.
  • It is dangerous to perform the block in the presence of a large aortic aneurysm (swelling of the main down pipe from the heart).

Technique

  • The block is performed using X-ray screening, intravenous sedation , local anaesthetic infiltration of the superficial layers, with the patient in the prone position (face down).
  • Using X-ray screening, the needle is inserted about 10 - 12 cm from the midline, and advanced so that initially touches the side of L2 vertebral body. It is then withdrawn slightly and readvanced until it slips past the anterolateral border of the vertebral body
  • Radio-opaque dye is injected to confirm correct needle position &
  • Drugs injected .
  • The same is done for the L3 and L4 levels.

Complications

  • Genitofemoral Neuralgia occurs in 5% of all blocks. This causes pain in the L1 groin area and is thought to be due to bruising of the L1 nerve root by the needle passing by it. More than 90% of cases recover spontaneously after 6 weeks.
  • Bleeding due to aorta and inferior vena cava injury by the needle.
  • Intravascular injection (should be prevented by checking the needle position with radio-opaque dye).
  • Upper abdominal organ puncture with abscess / cyst formation.