Complications of chemical lumbar sympathectomy and preventive measures

Abstract

Objective To summarize the common complications of chemical lumbar sympathectomy (CLS) and corresponding preventive measures. Methods A retrospective study was conducted on 258 cases of CT-guided CLS(injection of anhydrous alcohol) performed between September 2011 and September 2016 at Department of Pain Medicine, the First Hospital of Jiaxing City, and the complications and corresponding measures of prevention and treatment were analyzed. Results Surgical targets were successfully reached following the preplanned trajectories in all 258 cases (516 sides) undergoing CLS. In 16 cases (single side), a small amount of blood was observed when the plunger was pulled back and the position of needle tip was adjusted(3.1%, 16/516). In 29 cases (single side), some anhydrous alcohol leaked along the needle tract into the psoas major muscle and caused numbness in the area innervated by unilateral genital nerve in 7 cases and numbness and muscle weakness in unilateral lower limb in 1 case whose muscle strength recovered at 1 month post injection of diluted saline into the psoas major muscle. In 9 cases, anhydrous alcohol spread along the anterolateral margin of vertebral body upward to the level of L1 unilaterally(1.7%, 9/516), among which 4 male(1.6%, 4/258) patients developed ejaculatory dysfunction post surgery. Postoperative CT scan revealed unilateral swelling of psoas major muscle in 2 cases, unilateral swelling of erector spinae muscle in 3 cases. No retroperitoneal hematoma occurred. Conclusions The most severe complication of CT-guided CLS seems to be neurological dysfunctions following injection of anhydrous alcohol affecting the lumbar plexus and L1 sympathetic ganglia in male. Test with local anesthetics could be useful for preventing and early detection of those complications, and implementation of saline dilution might serve as an effective treatment. Key words: Autonomic nerve block; Complications; Ethanol; Chemical sympathectomy