Sympathetic block: Thoracic and lumbar

Abstract

Since Leriche’s initial reports of pain relief in patients with causalgia and reflex sympathetic dystrophy, the use of sympathetic blocks has become a common interventional technique. Current indications for sympathetic blocks include the diagnosis and treatment of painful neuropathic conditions and certain visceral pain syndromes. In the present article three sympathetic blocks are described including thoracic, splanchnic/celiac and lumbar sympathetic blocks. The thoracic sympathetic block is infrequently selected as a target for treatment because of the risk of pneumothorax, but may be effective for the management of complex regional pain syndrome (CRPS), neuropathic pain, postherpetic neuralgia, thoracic and upper abdominal visceral pain as well as postmastectomy syndrome. The splanchnic and celiac plexus blocks are indicated in the treatment of upper abdominal pain including cancer pain, abdominal angina, hepatobiliary disorders, and acute or chronic pancreatitis. Potential complications with these techniques include hypotension, diarrhea, and visceral injury. Lumbar sympathetic block may be useful in the management of painful neuropathic conditions associated with dysfunction of the sympathetic nervous system or peripheral vascular insufficiency. Like any other major sympathetic block, vasodilation in the vascular bed leading to hypotension may be life threatening and an intravenous access at the time and after the procedure is strongly recommended. In conclusion, when properly performed, sympathetic blockade techniques can be a safe clinical tool for the management of neuropathic and visceral pain conditions when other, less invasive, therapeutic options have failed.