Lumbar Sympathetic Ganglion Block Research Articles

The analgesic effect of lumbar sympathetic ganglion block in patients with failed back surgery syndrome.

Persistent or recurrent lumbosacral pain is a common symptom after spinal surgery. Several interventions have been introduced for failed back surgery syndrome; however, their clinical efficacy, safety, and cost-effectiveness are insufficient. Sympathetic ganglion block has been selected for pain associated with the sympathetic nervous system. In this study, we compared pain and quality of life in patients with failed back surgery syndrome who responded and did not respond to lumbar sympathetic ganglion block. We included 84 patients diagnosed with failed back surgery syndrome who had lumbosacral pain and underwent lumbar sympathetic ganglion block between January 2020 and April 2021. The patients' data were retrospectively analyzed; clinical outcomes were assessed before (T0), 1 week after (T1), and 4 weeks after (T4) lumbar sympathetic ganglion block. Based on the pain difference from T0 to T1, we categorized patients into two groups: patients with ≥ 50% pain reduction (responder group) and patients with < 50% pain reduction (non-responder group). Demographic, clinical, surgical, and fluoroscopic data were evaluated and compared. The primary outcome was pain scores and the EuroQol-5D score from T0 to T4. Among the 84 patients analyzed, 41 (48.8%) experienced ≥ 50% pain reduction at 1 week after lumbar sympathetic ganglion block. Lumbar sympathetic ganglion block significantly improved pain at T1 and T4 compared to T0 in both groups. Lumbar sympathetic ganglion block improved the EuroQol-5D score at T1 compared to T0 in the responder group. The responder group had a significant decrease in pain at T1 from T0 and T4 from T0 and a significant decrease in the EuroQol-5D score at T1 from T0 compared with the non-responder group. Coldness of the leg over time did not differ between the groups. No serious adverse events occurred in either of the groups. Lumbar sympathetic ganglion block may improve pain at 1 and 4 weeks in patients with failed back surgery syndrome. Patients with ≥ 50% pain reduction at 1 week showed simultaneous improvement in quality of life and pain reduction at 4 weeks. https://cris.nih.go.kr/cris/index/index.do, identifier KCT0007236.

Efficacy of the lumbar sympathetic ganglion block in lower limb pain and its application prospects during the perioperative period.

The sympathetic nervous system is involved in the physiological pathogenesis of many different types of chronic pain. Sympathetic blocks can interrupt the reflex control system by intercepting the noxious afferent fibers accompanying autonomic nerves, resulting in changes in peripheral or central sensory processing. A lumbar sympathetic ganglion block (LSGB), as a treatment method, refers to the injection of nerve blockers into the corresponding lumbar sympathetic nerve segments, usually requiring imaging assistance (CT,X-ray, ultrasound) to guide. At present, LSGB has been widely used in the clinical treatment of lower limb pain, such as neuropathic pain, lower limb ischemic pain, and so on. Its mechanism of action may be through inhibiting sympathetic nerve activity and dilating blood vessels, thereby alleviating pain and inhibiting stress response. However, there are few reports of LSGB duringthe perioperative period, especially in postoperative pain and gastrointestinal function. Therefore, by studyingthe literature about LSGB-relatedstudies, this article reviews the anatomy of the lumbar sympathetic nerve (LSN), with its clinical application and possible mechanism. We reviewed the analgesic effect of LSGB in patients with lower limb pain and postoperative pain and the potential application prospects in the recovery of gastrointestinal function, finally providing a reference for its clinical application.

Treatment of post-lumbar sympathetic neurolysis neurologic complications using a transforaminal epidural block: A case report

Background: A lumbar sympathetic ganglion block is useful for controlling neuropathic pain. Although the procedure is relatively safe, the use of chemical neurolytic agents may cause neurological complications. We underwent lumbar sympathetic ganglion neurolysis, and thereafter, neurological complications occurred. There is no specific treatment for neurologic complications after neurolysis using chemical agents, and a patient-specific approach is required. In this case, the pain intensity decreased step-by-step after transforaminal epidural block and interlaminar epidural block. We wrote about this treatment experience.Case presentation: A 45-year-old male patient underwent closed reduction and external fixation surgery for a left distal tibiofibular fracture and was subsequently diagnosed with complex regional pain syndrome. Lumbar sympathetic ganglion neurolysis was performed for treatment, but sensory loss of the L2 and L3 dermatomes and adductor muscle weakness of the lower leg occurred. Transforaminal epidural block and interlaminar epidural block were repeatedly performed to treat complications, and these procedures helped control the symptoms.Conclusions: When neurological complications occur after lumbar sympathetic neurolysis, an excellent therapeutic effect can be expected if transforaminal epidural block is used together with palliative treatment.

This Month in Anesthesiology

This Month in Anesthesiology

Botulinum Toxin Type A for Lumbar Sympathetic Ganglion Block in Complex Regional Pain Syndrome: A Randomized Trial.

The present study was designed to test the hypothesis that botulinum toxin would prolong the duration of a lumbar sympathetic block measured through a sustained increase in skin temperature. The authors performed a randomized, double-blind, controlled trial to investigate the clinical outcome of botulinum toxin type A for lumbar sympathetic ganglion block in patients with complex regional pain syndrome. Lumbar sympathetic ganglion block was conducted in patients with lower-extremity complex regional pain syndrome using 75 IU of botulinum toxin type A (botulinum toxin group) and local anesthetic (control group). The primary outcome was the change in the relative temperature difference on the blocked sole compared with the contralateral sole at 1 postoperative month. The secondary outcomes were the 3-month changes in relative temperature differences, as well as the pain intensity changes. A total of 48 participants (N = 24/group) were randomly assigned. The change in relative temperature increase was higher in the botulinum toxin group than in the control group (1.0°C ± 1.3 vs. 0.1°C ± 0.8, respectively; difference: 0.9°C [95% CI, 0.3 to 1.5]; P = 0.006), which was maintained at 3 months (1.1°C ± 0.8 vs. -0.2°C ± 1.2, respectively; P = 0.009). Moreover, pain intensity was greatly reduced in the botulinum toxin group compared with the control group at 1 month (-2.2 ± 1.0 vs. -1.0 ± 1.6, respectively; P = 0.003) and 3 months (-2.0 ± 1.0 vs. -0.6 ± 1.6, respectively; P = 0.003). There were no severe adverse events pertinent to botulinum toxin injection. In patients with complex regional pain syndrome, lumbar sympathetic ganglion block using botulinum toxin type A increased the temperature of the affected foot for 3 months and also reduced the pain.

Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial.

BackgroundThe study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic.MethodsIn this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed.ResultsProcedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study.ConclusionsVR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.

Clinical Trial of Ultrasound Combined With Computed Tomography Guided Lumbar Sympathetic Ganglion Block

Clinical Trial of Ultrasound Combined With Computed Tomography Guided Lumbar Sympathetic Ganglion Block

Efficacy of ultrasound-guided lumbar sympathetic ganglion block: a comparison with CT guidance

Efficacy of ultrasound-guided lumbar sympathetic ganglion block: a comparison with CT guidance

Lumbar Sympathetic Block with Botulinum Toxin Type A and Type B for the Complex Regional Pain Syndrome.

A lumbar sympathetic ganglion block (LSB) is a therapeutic method for complex regional pain syndrome (CRPS) affecting the lower limbs. Recently, LSB with botulinum toxin type A and B was introduced as a novel method to achieve longer duration of analgesia. In this study, we compared the botulinum toxin type A (BTA) with botulinum toxin type B (BTB) in performing LSB on patients with CRPS. LSB was performed with either BTA or BTB on patients with CRPS in their lower extremities. The length of time taken for patients to return to the pre-LSB pain score and the adverse effect of LSB with BTA/BTB were investigated. The median length of time taken for the patients to return to the pre-LSB pain score was 15 days for the BTA group and 69 days for the BTB group (P = 0.002). Scores on a visual analogue scale decreased in the patients of both groups, and no significant adverse effects were experienced. In conclusion, the administration of either BTA or BTB for LSB is a safe method to prolong the sympathetic blocking effect in patients with CRPS. BTB is more effective than BTA to prolong the sympathetic blocking effect in CRPS patients.

A brief report on a technical description of ultrasound-guided lumbar sympathetic block.

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.

Clinical Identification of the Vertebral Level at Which the Lumbar Sympathetic Ganglia Aggregate.

BackgroundThe location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate.MethodsSeventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes.ResultsThe median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up.ConclusionsSelection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.

The Effect of Lumbar Sympathetic Ganglion Block on Gynecologic Cancer-Related Lymphedema

Background: Eighteen to 25% of patients after gynecological cancer treatment suffer from lower limb lymphedema (LLL) that decreases the quality of life of gynecological cancer survivors. Lumbar sympathetic ganglion block (LSGB) is widely used in practice for the evaluation and management of sympathetically mediated pain in the lower limbs. Several articles have suggested that sympathetic ganglion block could be an effective treatment for lymphedema. Objectives: To investigate the effect of LSGB on patients with secondary lymphedema related to the treatment of gynecologic cancer, who do not respond to a conservative treatment. Study Design: Prospective clinical study. Setting: A single academic medical center, outpatient setting. Methods: Eighteen patients with stage II lower limb lymphedema who did not response to the conservative treatment were recruited. The patients underwent fluoroscopy-guided LSGB 3 times at 2-week intervals. The circumference of the thigh and calf was measured in the upright position at the first visit and 2 weeks after each session of LSGB. The pain score of the lower limb was checked at the same time by a numeric rating scale (NRS) from 0 to 10. The patients were asked about their satisfaction with the procedure at the last follow-up visit. The Wilcoxon signed rank test was used for data analysis. Significance was accepted at a P-value less than 0.05/3. Results: The circumferences of affected thighs and calves decreased from 56.38 ± 4.77 and 35.33 ± 3.51cm to 54.42 ± 5.27 and 34.41 ± 3.35cm, respectively, in a significant manner after 3 consecutive LSGBs (P &lt; 0.05/3). The maximal decrease after the third LSGB was 4 cm in the thigh and 2cm in the calf. The pain score also showed a significant decrease after 3 consecutive LSGBs from 2.17 to 1.28. The tightness and heaviness of the affected limb decreased after the first LSGB in 15 patients (83.3%) and after the second LSGB in 2 patients (11.1%). Five of 18 patients (27.8%) answered that the result of the LSGB met their expectations, 10 (55.6%) answered they would undergo the same treatment for the same outcome, 2 (11.1%) answered they did not improve as much as they had hoped, and they would not undergo the same treatment for the same outcome, and only one patient (5.6%) answered the LSGB showed no effect. Limitations: This study lacks a placebo control group and has only 18 patients. We did not evaluate the quality of life of the patients. Conclusion: We suggest that LSGB can be one of the treatment options for patients suffering from LLL after gynecologic cancer treatment. Our result could provide a basis for a randomized controlled trial in future investigations. The pain physicians can play an important role as one of the multidisciplinary team for a comprehensive treatment of LLL. Key words: Lumbar sympathetic ganglion block;gynecologic cancer;lymphedema

Effect of lumbar sympathetic ganglion block in patients with lymphedema after the treatment of gynecologic cancer: A preliminary report

Effect of lumbar sympathetic ganglion block in patients with lymphedema after the treatment of gynecologic cancer: A preliminary report

Phantom bladder pain

Phantom bladder pain

A Prospective Evaluation of Psoas Muscle and Intravascular Injection in Lumbar Sympathetic Ganglion Block

Intravascular and intramuscular injection of local anesthetics during lumbar sympathetic ganglion block (LSGB) can cause false positive or negative results in a diagnostic block, and complications. In the present study, we prospectively evaluated the incidence and possible factors causing intravascular and IM injection during LSGB. We evaluated 216 LSGBs in 83 patients. All LSGBs were performed by 1 of the authors using a 3-needle technique. After final needle position was confirmed by biplanar fluoroscopy, an aspiration test was conducted, and 1 mL of contrast was injected sequentially. Incidences of psoas muscle injection, blood flashback, and the presence of intravascular contrast spread on static and real-time fluoroscopy were assessed. The incidence of psoas muscle injection of contrast was 21.3% (46/216), and it was associated with the level of injection (L2) significantly (chi(2) = 14.773, P = 0.001). The incidence of intravascular injection of contrast was 12.5% (27/216). Among 27 cases of documented intravascular injections, 5.1% (11/216) of patients showed contrast spread at the area where the sympathetic ganglion was presumed to be and to the vessels simultaneously, and 7.4% (16/216) of patients showed only intravascular injection of contrast. The sensitivity of the aspiration test and static radiography were 40.7% and 70.4%, respectively. LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast in comparison with LSGB at L3 and L4. The aspiration test and static radiography frequently missed the intravascular injection of contrast during LSGBs.

Comparison of Multilevel with Single Level Injection during Lumbar Sympathetic Ganglion Block: Efficacy of Sympatholysis and Incidence of Psoas Muscle Injection

BackgroundWe prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect.MethodsAmong 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups.ResultsThe incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (χ2 = 14.773, P = 0.001). DTpost (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 ± 2.8℃, 1.8 ± 1.6℃, P < 0.001 for group A and B) and DTnet (DTpost - DTpre, 3.9 ± 2.7℃, 1.5 ± 1.5℃, P < 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 ± 0.9 for group A and 3.2 ± 1.6 for group B (P < 0.001).ConclusionsThe LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DTnet and DTpost.

Determination of Adequate Entry Angle of Lumbar Sympathetic Ganglion Block in Korean

BackgroundThe target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images.MethodsThe abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured.ResultsThere was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was 30.5 ± 0.4° and entry point was 7.7 ± 0.2 cm and 6.7 ± 0.1 cm lateral from midline in males and females respectively.ConclusionsThese measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.

Lumbar sympathetic ganglion block for possible CRPS: report of a case

Lumbar sympathetic ganglion block for possible CRPS: report of a case

A Case of Werner Syndrome Successfully Treated with the Lumbar Sympathetic Ganglion Block

A Case of Werner Syndrome Successfully Treated with the Lumbar Sympathetic Ganglion Block

Lumbar Sympathetic Ganglion Block May Improve Unilateral Leg Edema

Lumbar Sympathetic Ganglion Block May Improve Unilateral Leg Edema