Advertisement

Lumbar Sympathetic Treatment in the Management of Lower Limb Pain

  • Ronnen AbramovEmail author
Anesthetic Techniques in Pain Management (D Wang, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Anesthetic Techniques in Pain Management

Abstract

The sympathetic system has been a target for interventional treatment since the early half of the 20th century. One area targeted for treatment has been the lumbar sympathetics for lower limb pain. Physicians have treated various neuropathic and ischemic conditions employing the use of sympathetic procedures as a mode of treatment, yet the studies strongly supporting the utility of the procedure have been lacking. Anatomic studies have brought to light the complexity and variation that exists with identifying the locations of the ganglion. Studies have investigated the different methods to determine the highest yield and less risky approaches in performing the technique. Many studies have reported positive results with blockade and neurolysis, but review of the literature reveals poor strength quality and small sample population. These reports should be viewed as building blocks for more robust investigation. Interpretation of the results should be performed with caution, and translation into common practice implemented on a case by case basis.

Keywords

Interventional pain management Lumbar sympathetic block Lumbar sympathetic neurolysis Sympathetic ganglion Lower limb pain Neuropathic pain Ischemic pain 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

R. Abramov declares that he has no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

  1. 1.
    Yi X, AuBuchon J, Zeltwanger S, Kirby JP. Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block: a case report and review of literature. Clin J Pain. 2011;27:457–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Cheng J, Daftari A, Zhou L. Sympathetic blocks provided sustained pain relief in a patient with refractory painful diabetic neuropathy. Case Rep Anesthesiol. 2012;2012:1–5.CrossRefGoogle Scholar
  3. 3.
    Gebauer A, Schultz CR, Giangarra CE. Chronic exercise-induced leg pain in an athlete successfully treated with sympathetic block. Am J Sports Med. 2005;33:1575–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Datta S, Pai U. Paradiscal extraforaminal technique for lumbar sympathetic block: report of a proposed new technique utilizing a cadaver study. Pain Physician. 2004;7:53–7.PubMedGoogle Scholar
  5. 5.
    Rocco AG, Palombi D, Raeke D. Anatomy of the lumbar sympathetic chain. Reg Anesth. 1995;20:13–9.PubMedGoogle Scholar
  6. 6.
    Umeda S, Arai T, Hatano Y, Mori K, Hoshino K. Cadaver anatomic analysis of the best site for chemical lumbar sympathectomy. Anesth Analg. 1987;66:643–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Kirvelä O, Svedström E, Lundbom N. Ultrasonic guidance of lumbar sympathetic and celiac plexus block: a new technique. Reg Anesth. 1992;17:43–6.PubMedGoogle Scholar
  8. 8.
    König CW, Schott UG, Pereira PL, et al. MR-guided lumbar sympathicolysis. Eur Radiol. 2002;6:1388–93.CrossRefGoogle Scholar
  9. 9.
    Schmid MR, Kissling RO, Curt A, Jaschko G, Hodler J. Sympathetic skin response: monitoring of CT-guided lumbar sympathetic blocks. Radiology. 2006;241:595–602.PubMedCrossRefGoogle Scholar
  10. 10.
    Rocco AG. Radiofrequency lumbar sympatholysis: the evolution of a technique managing sympathetically mediated pain. Reg Anesth. 1995;20:3–12.PubMedGoogle Scholar
  11. 11.
    Wallace G. A lateral approach for lumbar sympathetic nerve block. Anesthesiology. 1955;16:254–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Clark AJ, Houlton PG, Purkis IE, Shukla RC. Lumbar-sympathetic blockade. is a single-needle technique adequate? Clin J Pain. 1988;4:213–6.CrossRefGoogle Scholar
  13. 13.
    Hong JH, Oh MJ. Comparison of multilevel with single level injection during lumbar sympathetic ganglion block: efficacy of sympatholysis and incidence of psoas muscle injection. Korean J Pain. 2010;23:131–6.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ohno K, Oshita S. Transdiscal lumbar sympathetic block: a new technique for a chemical sympathectomy. Anesth Analg. 1997;85:1312–6.PubMedGoogle Scholar
  15. 15.
    Price DD, Long S, Wilsey B, Rafii A. Analysis of peak magnitude and duration of analgesia produced by local anesthetics injected into sympathetic ganglia of complex regional pain syndrome patients. Clin J Pain. 1998;14:216–26.PubMedCrossRefGoogle Scholar
  16. 16.
    Jackson TP, Gaeta R. Neurolytic blocks revisited. Curr Pain Headache Rep. 2008;12:7–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Carroll I, Clark JD, Mackey S. Sympathetic block with botulinum toxin to treat complex regional pain syndrome. Ann Neurol. 2009;65:348–51.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Chen LC, Wong CS, Huh BK, et al. Repeated lumbar sympathetic blockade with lidocaine and clonidine attenuates pain in complex regional pain syndrome type 1 patients–a report of 2 cases. Acta Anaesthesiol Taiwan. 2006;44:113–7.PubMedGoogle Scholar
  19. 19.
    Bonica JJ, Buckley FP. Regional analgesia with local anesthetics. In: Bonica JJ, editor. The management of pain. Philadelphia: Lea & Febiger; 1990. p. 1883–966.Google Scholar
  20. 20.
    van Eijs F, Stanton-Hicks M, Van Zundert J, et al. Evidence-based interventional pain medicine according to clinical diagnoses. 16. Complex regional pain syndrome. Pain Pract. 2011;11:70–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Bogduk N. Diagnostic nerve blocks in chronic pain. Best Pract Res Clin Anaesthesiol. 2002;16:565–78.PubMedCrossRefGoogle Scholar
  22. 22.
    Haynsworth RF, Noe CE. Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis. Anesthesiology. 1991;74:459–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Noe CE, Haynsworth RF. Lumbar radiofrequency sympatholysis. J Vasc Surg. 1993;17:801–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Manjunath PS, Jayalakshmi TS, Dureja GP, Prevost AT. Management of lower limb complex regional pain syndrome type 1: an evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis—a pilot study. Anesth Analg. 2008;106:647–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Verma YS, Thakur JR, Sodhi SS. Evaluation of chemical lumbar sympathectomy for chronic arterial ischaemia of lower limb(s). J Anaesthesiol Clin Pharmacol. 2007;23:391–4.Google Scholar
  26. 26.
    Straube S, Derry S, Moore RA, McQuay HJ. Cervico-thoracic or lumbar sympathectomy for neuropathic pain and complex regional pain syndrome. Cochrane Database Syst Rev. 2010;7:1–15.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Department of Anesthesiology, Department of RehabilitationThomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations