Advertisement

Thoracic and Lumbar Sympathetic Nerve Block and Neurolysis

  • Tim J. Lamer
  • Jason S. Eldrige
Chapter

Abstract

Sympathetic blockade of the thoracic and lumbar regions has been long described in the medical literature; initial techniques for a percutaneous thoracic block (paravertebral approach) were documented by Kappis in 1919. Earlier descriptions which postulated the role of the sympathetic system in the development and maintenance of neuropathic pain are detailed in the medical literature of the early 1900s. The sympathetic contribution to so-called causalgia was theorized in 1916 by Leriche, who argued that periarterial excision of sympathetic fibers may be of therapeutic benefit in relieving pain.

Keywords

Vertebral Body Complex Regional Pain Syndrome Stellate Ganglion Sympathetic Chain Sympathetic Block 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Kappis M. Sensibilitt und local ansthesie in chirurgischen gebiet der bauchhole mit besonderen bercksichtigung der splanchnichusansthesie. Bruns Beitr Klin Cher. 1919;15:161.Google Scholar
  2. 2.
    Finch P. Sympathetic neurolysis. In: Raj PP, editor. Textbook of regional anesthesia. Churchill Livingstone in cooperation with W B Saunders New York; 2002, p. 667–85.Google Scholar
  3. 3.
    Skabelund C, Racz G. Indications and technique of thoracic 2 and thoracic 3 neurolysis. Curr Rev Pain. 1999;3:400–5.CrossRefGoogle Scholar
  4. 4.
    Marhold F, et al. Thoracoscopic and anatomic landmarks of Kuntz’s nerve: implications for sympathetic surgery. Ann Thorac Surg. 2008;86:1653–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Ohseto K. Efficacy of thoracic sympathetic ganglion block and prediction of complications: clinical evaluation of the anterior paratracheal and posterior paravertebral approaches in 234 patients. J Anesth. 1992;6(3):316–31.PubMedCrossRefGoogle Scholar
  6. 6.
    Wilkinson HA. Radiofrequency percutaneous upper-thoracic sympathectomy. Technique and review of indications. N Engl J Med. 1984;311(1):34–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Cowie B, et al. Ultrasound-guided thoracic paravertebral blockade: a cadaveric study. Anesth Analg. 2010;110(6):1735–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Stanton-Hicks M. Thoracic sympathetic block: a new approach. Tech Reg Anesth Pain Manag. 2001;5(3):94–8.CrossRefGoogle Scholar
  9. 9.
    Raj PP, et al. Interventional pain management: image-guided procedures. Philadelphia: Saunders Elsevier; 2008.Google Scholar
  10. 10.
    Fishman SM, Ballantyne JC, Rathmell JP. Bonica’s management of pain, in various chapters. Philadelphia: Lippincott Williams & Wilkins; 2009.Google Scholar
  11. 11.
    Lamer T. Sympathetic nerve blocks. In: Regional anesthesia and analgesia. Philadelphia: WB Saunders; 1996. p. 357–84.Google Scholar
  12. 12.
    Brown D. Atlas of regional anesthesia, in atlas of regional anesthesia. Philadelphia: Saunders Elsevier Publishing; 2006.Google Scholar
  13. 13.
    Day M. Sympathetic blocks: the evidence. Pain Pract. 2008;8(2):98–109.PubMedCrossRefGoogle Scholar
  14. 14.
    Loeser JD, Bonica JJ. Bonica’s management of pain. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. xxii, 2178 p.Google Scholar
  15. 15.
    Cowley RA, Yeager GH. Anatomic observations on the lumbar sympathetic nervous system. Surgery. 1949;25(6):880–90.PubMedGoogle Scholar
  16. 16.
    Gray H, Goss CM. Anatomy of the human body. 29th ed. Philadelphia: Lea & Febiger; 1973. p. xvii, 1466 p.Google Scholar
  17. 17.
    Leriche R. L’anesthesie isolee du ganglion etoile: sa technique, ses indications, ses resultats. Presse Med. 1934;42:849–50.Google Scholar
  18. 18.
    Meier PM, et al. Lumbar sympathetic blockade in children with complex regional pain syndromes: a double blind placebo-controlled crossover trial. Anesthesiology. 2009;111(2):372–80.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Kramis RC, Roberts WJ, Gillette RG. Post-sympathectomy neuralgia: hypotheses on peripheral and central neuronal mechanisms. Pain. 1996;64(1):1–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Cousins MJ, Bridenbaugh PO. Neural blockade in clinical anesthesia and management of pain. 2nd ed. Philadelphia: Lippincott; 1988. p. xix, 1171 p.Google Scholar
  21. 21.
    Heindel W, et al. CT-guided lumbar sympathectomy: results and analysis of factors influencing the outcome. Cardiovasc Intervent Radiol. 1998;21(4):319–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Tran KM, et al. Lumbar sympathetic block for sympathetically maintained pain: changes in cutaneous temperatures and pain perception. Anesth Analg. 2000;90(6):1396–401.PubMedCrossRefGoogle Scholar
  23. 23.
    Cepeda MS, Carr DB, Lau J. Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database Syst Rev. 2005;4:CD004598.PubMedGoogle Scholar
  24. 24.
    Cousins MJ, et al. Neurolytic lumbar sympathetic blockade: duration of denervation and relief of rest pain. Anaesth Intensive Care. 1979;7(2):121–35.PubMedGoogle Scholar
  25. 25.
    Froysaker T. Lumbar sympathectomy in impending gangrene and foot ulcer. Scand J Clin Lab Invest Suppl. 1973;128:71–2.PubMedGoogle Scholar
  26. 26.
    Fyfe T, Quin RO. Phenol sympathectomy in the treatment of intermittent claudication: a controlled clinical trial. Br J Surg. 1975;62(1):68–71.PubMedCrossRefGoogle Scholar
  27. 27.
    Haimovici H, Steinman C, Karson IH. Evaluation of lumbar sympathectomy. Advanced occlusive arterial disease. Arch Surg. 1964;89:1089–95.PubMedCrossRefGoogle Scholar
  28. 28.
    Hughes-Davies DI, Redman LR. Chemical lumbar sympathectomy. Anaesthesia. 1976;31(8):1068–75.PubMedCrossRefGoogle Scholar
  29. 29.
    Mashiah A, et al. Phenol lumbar sympathetic block in diabetic lower limb ischemia. J Cardiovasc Risk. 1995;2(5):467–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Myers KA, Irvine WT. An objective study of lumbar sympathectomy-II. Skin ischaemia. Br Med J. 1966;1(5493):943–7.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Rosen RJ, et al. Percutaneous phenol sympathectomy in advanced vascular disease. AJR Am J Roentgenol. 1983;141(3):597–600.PubMedCrossRefGoogle Scholar
  32. 32.
    Strand L. Lumbar sympathectomy in the treatment of peripheral obliterative arterial disease. An analysis of 167 patients. Acta Chir Scand. 1969;135(7):597–600.PubMedGoogle Scholar

Copyright information

© American Academy of Pain Medicine 2015

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain ClinicRochester Methodist Hospital, Mayo ClinicRochesterUSA
  2. 2.Mayo College of MedicineRochesterUSA

Personalised recommendations