Background: Lumbar sympathetic ganglion blockade (LSGB) is traditionally performed using x-ray in either the fluoroscopy suite, or CT in the radiology department. This case series evaluated the feasibility of using the ' Shamrock method'to perform LSGB under ultrasound guidance in patients. Methods: A total of 16 patients with postherpetic neuralgia received a real-time LS-GB under the guidance of Shamrock ultra-sonogram for pain management. The blocks were performed using the in-plane needle insertion. Ultrasound visibility of the lumbar paravertebral structures was assessed in real time during the scout scan. Sympathetic block after LSGB was considered successful when changes in ipsilateral skin temperature between preblock and postblock were >2℃. Results: The lumbar paravertebral region was successfully visualized in all patients with a median ultrasound visibility score of 15 (range, 8-18). The skin temperature of the big toe before LSGB was significantly lower than that 20 minutes after LSGB. Additionally, the changes in skin temperature between preblock and postblock were >2℃ in 15 (93.8%) of 16 patients. Conclusions: Ultrasound-guided LSGB can be reliably accomplished using the Shamrock method.
Background: Imaging-guided celiac plexus neurolysis using ultrasound (US) guidance via a transabdominal approach and endoscopic-ultrasound (EUS) has been increasingly applied for the treatment of pancreatic cancer-associated abdominal pain. Objective: To investigate the application of ultrasound-guided and fluoroscopy-assisted celiac plexus neurolysis in a patient with advanced pancreatic cancer suffering from refractory abdominal pain for which oral opioid treatment was ineffective. Case Report: We report a case of ultrasound-guided and fluoroscopy-assisted celiac plexus neurolysis in a patient with advanced pancreatic cancer with refractory abdominal pain. With the patient in the prone position, celiac plexus neurolysis was performed under real-time US guidance. The transducer was placed below the costal margin and a puncture needle with an ultrasound enhancement tip was inserted in-plane aiming for the lateral anterior end of the vertebral body. The correct needle tip position was confirmed by the C-arm with contrast material located anterior to the vertebral body and posterior to the diaphragm. Conclusion: We highlight the use of an US-guided and fluoroscopy-assisted posterior approach for use in celiac plexus neurolysis procedures, particularly in patients suffering from contraindications from the US or EUS-guided anterior approaches.
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