Lumbar Sympathetic Ganglia Research Articles

The effects of lumbar sympathetic ganglion block therapy on secondary lower limb lymphedema among patients with gynecologic cancer surgery

The effects of lumbar sympathetic ganglion block therapy on secondary lower limb lymphedema among patients with gynecologic cancer surgery

CN78 The effects of lumbar sympathetic ganglion block therapy on secondary lower limb lymphedema

CN78 The effects of lumbar sympathetic ganglion block therapy on secondary lower limb lymphedema

Surgical Lumbar Sympathectomy in Mice.

Peripheral nerve injuries are common, and full functional recovery after injury is achieved in only 10% of patients. The sympathetic nervous system plays many critical roles in maintaining bodily homeostasis, but it has rarely been studied in the context of peripheral nerve injury. The extent of postganglionic sympathetic neuronal functions in distal targets in the periphery is currently unclear. To better explore the role of sympathetic innervation of peripheral targets, a surgical "knock-out" model provides an alternative approach. Although this can be achieved chemically, chemical destruction of postganglionic sympathetic neurons can be nonspecific and dose-dependent. The use of a surgical lumbar sympathectomy in mice, once thought to be "virtually not practicable" in small animals, allows for specific targeting of postganglionic sympathetic neurons that innervate the hind limbs. This manuscript describes how to surgically remove the L2-L5 lumbar sympathetic ganglia from a mouse as a survival surgery, which reliably decreases the hind paw sweat response and the number of sympathetic axons in the sciatic nerve.

Effect duration of lumbar sympathetic ganglion neurolysis in patients with complex regional pain syndrome: a prospective observational study

Lumbar sympathetic ganglion neurolysis (LSGN) has been used for long-term pain relief in patients with complex regional pain syndrome (CRPS). However, the actual effect duration of LSGN has not been accurately measured. This prospective observational study measured the effect duration of LSGN in CRPS patients and investigated the relationship between temperature change and pain relief. After performing LSGN, the skin temperatures of both the maximum pain site and the plantar area in the affected and unaffected limbs were measured by infrared thermography, and pain intensity was assessed before and at 2 weeks, 1 month, and 3 months. The median time to return to baseline temperature was calculated using survival analysis. The skin temperature increased significantly at all-time points relative to baseline in both regions (maximum pain site: 1.4 °C ± 1.0 °C, plantar region: 1.28 °C ± 0.8 °C, all P < 0.001). The median time to return to baseline temperature was 12 weeks (95% confidence interval [CI] 7.7–16.3) at the maximum pain site and 12 weeks (95% CI 9.4–14.6) at the plantar area. Pain intensity decreased significantly relative to baseline, at all-time points after LSGN. In conclusion, the median duration of the LSGN is estimated to be 12 weeks.

Effect of lumbar sympathetic ganglion radiofrequency therapy combined with anhydrous ethanol on pain relief in patients with osteonecrosis of the femoral head.

To explore the efficacy and safety of lumbar sympathetic ganglion radiofrequency combined with anhydrous ethanol in treating pain associated with osteonecrosis of the femoral head, providing clinical reference. This retrospective study involved 101 patients with osteonecrosis of the femoral head. According to the different treatment methods, the patients were classified into an observation group where lumbar sympathetic ganglion radiofrequency combined with anhydrous ethanol therapy was applied (n=51) and a control group where lumbar sympathetic ganglion radiofrequency alone was applied (n=50). The Visual Analogue Scale (VAS) was used to assess the joint pain. Harris hip joint scores, incidence of complications, levels of inflammatory factors (hs-CRP and IL-6), and overall therapeutic effects were also compared between the two groups. The total effective rate of the observation group was significantly higher than that of the control group (P<0.05). The VAS score of joint pain was significantly lower in the observation group as compared with the control group (P<0.05). Harris scores were higher in the observation group than in the control group (P<0.05). The observation group had significantly lower levels of hs-CRP and IL-6 than the control group (P<0.001). In addition, there was no difference between the two groups in the incidence of complications (P=0.11). Lumbar sympathetic ganglion radiofrequency combined with anhydrous ethanol provides an effective method for treating avascular necrosis of the femoral head, with good therapeutic effects on improving blood supply to the femoral head and relieving pain, and with good safety profile.

Computed tomography-controlled paravertebral sympathectomy in the treatment of obliterating diseases of the arteries of extremities

Surgeries on the paravertebral sympathetic ganglia still keep their meaning. They become surgeries of choice in cases of peripheral arterial damage. Sympathectomy ensures maximum arterial bed dilation, increases blood flow to the ischemic zone, accelerates the angiogenesis. Minimally invasive chemical destruction of the lumbar sympathetic ganglia under the control of a spiral computed tomograph is an alternative to surgical lumbar sympathectomy. It has comparable effectiveness in comparison with open intervention treatment both in the immediate and long-term periods. The study reflects the results of the influence of computed tomographically controlled puncture paravertebral sympathectomy on the symptoms of obliterating diseases of the arteries of lower extremities.

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.

A comprehensive study of the abdominal ganglia part 3: An overview of the most commonly observed ganglion patterns.

Chronic pain from untreatable abdominal cancers or pancreatitis can severely decrease an individual's quality of life due to accompanying neuropathic pain, the most difficult pain mechanism to treat. Current treatment modalities focus on peripheral block or neurolysis procedures of the sympathetic ganglia in an attempt to curb the pain and improve quality of life. Reports indicated that these treatments are ineffective with patients either experiencing no relief or return the pain in a few weeks. The aim of this study was to investigate the location, macro- and microscopic morphology, and interconnections of the abdominal ganglia. The abdominal sympathetic ganglia of nine adult cadavers were investigated. The locations, morphology, interconnections, and microscopic structure were studied in 108 potential abdominal ganglia. Particular emphasis was placed on direct interconnectivity between the ganglia and histological morphology. A total of 100 ganglia were confirmed histologically to contain ganglion cells. The number and locations of most of the ganglia identified in our study does not correspond to that described by previous reports. Numerous interconnections between the different ganglia, as well as direct communications with the lumbar sympathetic chain ganglia were observed. The interconnections and presence of ganglion cells the nerves connecting the ganglia lead to the belief that the system should be considered as a unit and that pain fibers may be transmitted via alternative previously undiscovered pathways. If the pain treatments are to be reassessed with this information in mind, we believe that greater success could be achieved.

A comprehensive study of the abdominal ganglia part 2: Aorticorenal ganglia.

Investigation into reports of pain treatment for abdominal cancer and abdominal pain syndromes revealed the lack of human studies on some of the abdominal sympathetic ganglia. Recent studies on renal artery denervation therapy as treatment for resistant hypertension has made the aorticorenal ganglia of particular importance. The aim of this study was to investigate the location, morphology, interconnections, and histological nature of aorticorenal ganglia. We dissected nine abdominal cavities and harvested 37 aorticorenal ganglia. Hematoxylin and Eosin, and Masson's staining techniques were used to study the histological structure. Additionally, ganglia harvested from five individuals were stained with immunohistochemical techniques to test for tyrosine hydroxylase activity. All aorticorenal ganglia were located in proximity to the renal artery, and the majority were close to the vessel origin. Identification of multiple aorticorenal ganglia was the norm, and ranged from 2 to 4 on the left and 1 to 3 on the right. While the pattern of aorticorenal ganglia seemed to be unique in each individual case, the interconnections between these and other ganglia were vast. The aorticorenal ganglia shared direct connections with the celiac, gonadal, inferior mesenteric, and first lumbar sympathetic trunk ganglion. Contributions from the greater, lesser, and least thoracic splanchnic nerves were also observed. While the results of our study may not have direct clinical implications in isolation, the vast number of interconnections with the other abdominal ganglia may cause complications in procedures such as celiac ganglion block. In addition, aorticorenal innervation interruption may lead to hypotension.

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.

Evaluation Of The Radiofrequency Ablation Of Lumbar Sympathetic Ganglia In Lower Limb Ischemic Ulcers In Indian Population

Antecedentes: la simpatectomía lumbar mediante radioablación es un tratamiento útil de la isquemia periférica. Sin embargo, la eficacia clínica con respecto a las úlceras de las extremidades inferiores no está suficientemente establecida en la población india. El estudio se realizó para evaluar el papel de la ablación por radiofrecuencia (ARF) de los ganglios simpáticos lumbares en la cicatrización de las úlceras isquémicas del miembro inferior. Método: El estudio prospectivo con 63 pacientes registrados en el servicio de Cirugía General con úlceras isquémicas de miembros inferiores entre diciembre de 2017 y julio de 2019 fueron tratados con ARF. Se excluyó del estudio a los pacientes con enfermedad cardiopulmonar, embarazadas, malformaciones congénitas o infección cutánea en el lugar de la intervención, o que padecían trastornos hemorrágicos. Se realizó una investigación clínica de la herida y se recopilaron datos demográficos. La reducción comparativa en el tamaño de la herida se evaluó mediante el ANOVA de Friedman (P &lt;0,001). La diferencia en la puntuación del dolor, la estancia hospitalaria y la distancia recorrida se evaluaron mediante la prueba de pares emparejados de Wilcoxon (P &lt;0,001), la prueba t para datos no emparejados y la prueba t para datos emparejados (P &lt;0,05). Resultado: la mayoría de los pacientes eran hombres (n = 40) con una edad media de 60,93 DE14,34 años. Se observó una reducción significativa en el tamaño de la herida, las puntuaciones de dolor y la estancia hospitalaria después del procedimiento (P &lt;0,001). El número de sesiones de RFA se asoció significativamente con el tamaño de la úlcera y la clasificación de Fontaine 2 y 3 (P &lt;0,0001). Conclusión: La ARF de los ganglios simpáticos lumbares es una posible modalidad de tratamiento para las úlceras isquémicas de las extremidades inferiores.

Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article.

IntroductionInterventional techniques such as radiofrequency (RF) treatment can be used to interrupt pain signals transmitted through the sympathetic nervous system (SNS). RF treatments including the pulsed (PRF) and continuous (CRF) modalities show enhanced control over lesion size and enhanced ability to confirm accurate positioning compared to other interventional methods. PRF also acts to reduce the area of the lesion. In this article, we characterize the currently available evidence supporting the use and efficacy of RF treatments in sympathetically mediated pain (SMP) conditions.Study DesignA comprehensive literature review.MethodsA PubMed and Cochrane Library database search was performed for human studies applying RF treatment at sympathetic sites (sphenopalatine ganglion, stellate ganglion, cervical, thoracic, or lumbar sympathetic ganglia, celiac plexus, splanchnic nerves, superior hypogastric plexus, and ganglion impar) between January 1970 to May 2020. Data were extracted, summarized into tables, and qualitatively analyzed.ResultsPRF and CRF both show promise in relieving SMP conditions, such as complex regional pain syndrome (CRPS), pain in the perineal region, headache and facial pain, and oncologic and non-oncologic abdominal pain, in addition to other types of pain, with minimal complications. Furthermore, in most comparative studies, outcomes using RF treatments exceeded other interventional techniques, such as anesthetic block and chemical neurolysis.ConclusionsRF treatments can be effective in carefully selected patients who are refractory to conservative management. However, further randomized controlled studies are needed prior to implementing it into common practice.

Study of Chemical Neurolysis, Radiofrequency Ablation and Combined Radiofrequency with Chemical Neurolysis of Lumbar Sympathetic Ganglion in Peripheral Vascular Diseases of the Lower Limbs

Lumbar sympathectomy is indicated for the treatment of intermittent claudication or rest pain in legs due to ischemia...

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

Efficacy of lumbar sympathetic ganglion pulsed radiofrequency in treatment of diabetic neuropathic pain

Objective To evaluate the efficacy of lumbar sympathetic ganglion pulsed radiofrequency (PRF) in treatment of diabetic neuropathic pain. Methods Forty-eight patients of both sexes with diabetic neuropathic pain, aged 45-75 yr, with the course of disease 4-7 yr, were divided into 2 groups (n=24 each) using a random number table method: control group (C group) and PRF group (P group). Group C was treated with conventional drugs.Bilateral lumbar sympathetic ganglion PRF was performed on the basis of conventional drug therapy in group P. The serum concentrations of tumor necrosis factor-alpha and interleukin-6 were measured by enzyme-linked immunosorbent assay.The visual analogue scale score was recorded before treatment and at 1, 2 and 4 weeks of treatment.The degree of efficacy was recorded at 4 weeks of treatment, and the total effective rate was calculated. Results Compared with group C, the visual analogue scale score and serum concentrations of tumor necrosis factor-alpha and interleukin-6 were significantly decreased, and the total effective rate and degree of curative efficacy were increased in group P (P<0.05). No pulsed radiofrequency-related complications or drugs-related adverse reactions were found in two groups. Conclusion Lumbar sympathetic ganglion PRF can effectively relieve diabetic neuropathic pain in the patients. Key words: Ganglia, sympathetic; Pulsed radiofrequency treatment; Diabetic neuropathies