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Sympathetic Blockade

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Essentials of Regional Anesthesia

Abstract

Percutaneous blockade of the sympathetic nervous system is a key component of a pain management physician’s skill set. These blocks can be used for diagnostic and therapeutic purposes and are generally indicated when conservative and pharmacological therapy is partially effective or ineffective in alleviating a patient’s chronic pain. More definitive treatment can be accomplished through radiofrequency or chemical neurolysis. Detailed knowledge of the relevant anatomy is key as this will theoretically improve efficacy and minimize complications.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Miles Day M.D.

  2. Anesthesiology and Pain Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Rafael Justiz M.D.

  3. Kinesiology and Sports Management, Texas Tech University, Lubbock, TX, USA

    Audra Day Ph.D.

  4. Department of Anesthesiology, UT Health San Antonio, San Antonio, TX, USA

    Maxim S. Eckmann M.D.

Authors
  1. Miles Day M.D.
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  2. Rafael Justiz M.D.
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  3. Audra Day Ph.D.
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  4. Maxim S. Eckmann M.D.
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Corresponding author

Correspondence to Miles Day M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    Prior to radiofrequency of the splanchnic nerves, sensory stimulation is carried out. Where will the patient perceive the stimulation?

    1. (a)

      Lower ribs in a dermatomal distribution

    2. (b)

      Pelvis

    3. (c)

      Deep in the abdomen

    4. (d)

      Sacrum

  2. 2.

    Which of the following is a side effect of a splanchnic/celiac block?

    1. (a)

      Backache

    2. (b)

      Neuraxial injection

    3. (c)

      Pneumothorax

    4. (d)

      Diarrhea

  3. 3.

    Sensory stimulation of the sphenopalatine ganglion will produce a paresthesia where?

    1. (a)

      Root of the nose

    2. (b)

      Posterior pharynx

    3. (c)

      Lower teeth

    4. (d)

      Hard palate

  4. 4.

    The target for a thoracic sympathetic block at T2 and T3 is:

    1. (a)

      The midpoint to posterior one third of the vertebral body in the anterior-posterior direction

    2. (b)

      The junction of the middle and lower third of the vertebral body in the cephalocaudal direction

    3. (c)

      The midpoint of the vertebral body in the cephalocaudal direction

    4. (d)

      The junction of the anterior and middle third of the vertebral body in the anterior-posterior direction

  5. 5.

    The appropriate contrast pattern on a lateral fluoroscopic view for a hypogastric plexus block is

    1. (a)

      Cephalad toward the L4–L5 interspace

    2. (b)

      Over the anterior aspect of the L5 vertebral body

    3. (c)

      Over the sacral promontory at the L5–S1 interspace

    4. (d)

      Caudal towards S2–S3

  6. 6.

    The final needle tip position for the trans-sacrococcygeal approach for the ganglion impar is:

    1. (a)

      Just anterior to the sacrococcygeal junction

    2. (b)

      Just posterior to the sacrococcygeal junction

    3. (c)

      1 cm anterior to the sacrococcygeal junction

    4. (d)

      In the sacrococcygeal joint

  7. 7.

    The parasympathetic component of the sphenopalatine ganglion originates from what brainstem nucleus?

    1. (a)

      Superior salivatory nucleus

    2. (b)

      Inferior salivatory nucleus

    3. (c)

      Nucleus ambiguus

    4. (d)

      Nucleus caudalis

  8. 8.

    The anterior tubercle of C6 is commonly referred to as:

    1. (a)

      Anderson’s tubercle

    2. (b)

      Chassaignac’s tubercle

    3. (c)

      Chavira’s tubercle

    4. (d)

      Silverman’s tubercle

  9. 9.

    Which of the following is a component of a Horner’s syndrome?

    1. (a)

      Exophthalmos

    2. (b)

      Mydriasis

    3. (c)

      Tongue deviation

    4. (d)

      Ptosis

  10. 10.

    Kuntz fibers are located at which vertebral body levels?

    1. (a)

      T1 and T2

    2. (b)

      T3 and T4

    3. (c)

      T2 and T3

    4. (d)

      C7 and T1

  11. 11.

    For a splanchnic nerve block at T11, the entry site of the needle should not be greater than 4 cm from the midline to avoid what complication?

    1. (a)

      Puncture of the aorta

    2. (b)

      Pneumothorax

    3. (c)

      Nerve root injury

    4. (d)

      Neuraxial injection

  12. 12.

    Because of its anatomical location, which of the following structures is more likely to be punctured when performing a left stellate ganglion block as compared to a right stellate ganglion block?

    1. (a)

      Trachea

    2. (b)

      Esophagus

    3. (c)

      Thyroid gland

    4. (d)

      Carotid artery

  13. 13.

    The transaortic neurolytic block of the celiac plexus requires what volume of neurolytic?

    1. (a)

      5 ml

    2. (b)

      10 ml

    3. (c)

      15 ml

    4. (d)

      20 ml

  14. 14.

    To perform a radiofrequency neurotomy of the L2, L3, and L4 sympathetic ganglia, where on the vertebral bodies should the needle tips be placed?

    1. (a)

      Middle of L2, middle of L3, and middle of L4

    2. (b)

      Upper one third of L2, lower one third of L3, and middle of L4

    3. (c)

      Lower one third of L2, upper one third of L3, and lower one third of L4

    4. (d)

      Lower one third of L2, upper one third of L3, and middle of L4

  15. 15.

    While performing sensory stimulation prior to radiofrequency lesioning of the L3 sympathetic ganglion, the patient feels a paresthesia in the groin. What is the appropriate next step?

    1. (a)

      Reposition the needle as it is close proximity to the genitofemoral nerve and retest.

    2. (b)

      Place local anesthetic and proceed with the lesioning as this is an expected response.

    3. (c)

      Proceed with lesioning as the sympathetic ganglion is not a sensory nerve and does not require local anesthetic.

    4. (d)

      Proceed with motor stimulation and if no motor response, proceed with lesioning.

Answers

  1. 1.

    c

  2. 2.

    d

  3. 3.

    a

  4. 4.

    b

  5. 5.

    c

  6. 6.

    a

  7. 7.

    a

  8. 8.

    b

  9. 9.

    d

  10. 10.

    c

  11. 11.

    b

  12. 12.

    b

  13. 13.

    c

  14. 14.

    d

  15. 15.

    a

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Day, M., Justiz, R., Day, A., Eckmann, M.S. (2018). Sympathetic Blockade. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_32

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_32

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  • Online ISBN: 978-3-319-74838-2

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