Lumbar Sympathetic Neurolysis: How to and When to Use?

Zechlinski, Joseph John; Hieb, Robert A.

doi:10.1053/j.tvir.2016.04.008

Cited by 19 publications

(15 citation statements)

References 9 publications

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“…Side effects include bleeding, nerve root injury, genitofemoral neuralgia, neuraxial injection, paralysis, and renal injury. Genitofemoral neuralgia is caused by injection into the psoas muscle [4]. Intramuscular injections occur more frequently when administered at multiple levels [12].…”

Section: Discussionmentioning

confidence: 99%

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Repeated Single Level Lumbar Sympathetic Neurolysis using Alcohol in a Plantar Hyperhidrosis Patient: A 5-year Follow-up Case Report

Jeon

Jin

et al. 2021

AJPNMS

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Background: Plantar hyperhidrosis causes discomfort in daily life. However, there are few reports on sympathetic neurolysis in plantar hyperhidrosis. Case: A 19-year-old woman complained of excessive sweating of both hands and feet. Using video-assisted thoracic surgery, the patient underwent bilateral T3 sympathectomy in the department of chest surgery. One year later, she visited pain clinic with with plantar hyperhidrosis and wanted to undergo sympathetic block. Lumbar sympathetic neurolysis was performed using 2.5 ml of pure anhydrous alcohol at the L4 vertebral level. The symptoms improved after the procedure, and there were no side effects. The patient again underwent sympathetic neurolysis as the symptoms recur. Conclusions: Repeated lumbar sympathetic neurolysis was performed in a patient with plantar hyperhidrosis, and its success was confirmed during 5 years of follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Lumbar sympathetic neurolysis is used to treat severe ischemic rest pain or peripheral arterial disease of the lower extremities. Furthermore, it can be used for the treatment of complex regional pain syndrome, peripheral vasospasm, postherpetic neuralgia, phantom limb pain, and plantar hyperhidrosis [4].…”

Section: Introductionmentioning

confidence: 99%

Repeated Single Level Lumbar Sympathetic Neurolysis using Alcohol in a Plantar Hyperhidrosis Patient: A 5-year Follow-up Case Report

Jeon

Jin

et al. 2021

AJPNMS

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“…Sympathetic nervous system involvement to the neuropathic, visceral, or vascular pain creates a rational basis to the treatment. [1][2][3][4] Postherpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by allodynia, hyperalgesia, and persistent pain that occurs after the acute onset of herpes zoster. The pain often affects individuals' quality of life and sleep, activities of daily living, and psychological status severely.…”

Section: Introductionmentioning

confidence: 99%

Lumbar Sympathetic Block for Intractable Lower‐Limb Postherpetic Neuralgia: Report of Two Cases

2020

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Lumbar sympathetic block is a commonly used technique for sympathetically mediated pain syndromes. Postherpetic neuralgia (PHN) is also accepted to be associated with sympathetic system activation. While sympathetic blocks were utilized for upper-extremity or face-related PHN, there has not been any report regarding lower-extremity PHN, as it is an uncommon region. Here, we present two cases of systemic drug-resistant PHN in lower limb, relieved with lumbar sympathetic block. Both patients had at least 50% reduction in numeric rating scale (NRS) scores at the end of 6 months. Lumbar sympathetic block could be considered in the treatment of lower-limb PHN. More reports and controlled trials are needed for further understanding the role of the intervention in this neuropathic pain syndrome. &

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“…The lumbar sympathetic block (LSB) is a proposed mechanism to treat visceral pain in diverse patient populations. It was first described by Jaboulay in 1899 and first performed via blind technique by Felix Mandl in 1924, but since 1944 it has been done primarily under fluoroscopy [3][4][5]. Blockade of the sympathetic chains between L1 and L4 is possible due to their predictable locations within the retroperitoneum, posterior to the great vessels and anterior to the psoas muscles and vertebral bodies [6].…”

Section: Introductionmentioning

confidence: 99%

The Use of L2 and L3 Lumbar Sympathetic Blockade for Cancer-Related Pain, an Experience and Recommendation in the Oncologic Population

et al. 2019

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Objective The sympathetic nervous system has a recognized role in transmission of pain, and the lumbar sympathetic blockade is intended to provide analgesia. We share our experiences of lumbar sympathetic blockade in the treatment of cancer-related pain. Methods We performed a retrospective analysis of patients with cancer-related pain in the back, abdomen, pelvis, or legs treated at Memorial Sloan Kettering Cancer Center between 2000 and 2018 undergoing lumbar sympathetic blockade at L2 or L3. Blocks were accomplished by injection of local anesthetic or local anesthetic with steroid under fluoroscopy. We measured numerical rating scale scores, percent relief, and relief time. The primary end point was defined as “effective” or “ineffective” pain relief. Effective pain relief was defined as ≥30% relief for at least one day. Results We identified 124 data points of lumbar sympathetic blockade at L2 or L3, of which 57 were with complete data and used for analysis. Peri-injection, 42 data points had active disease whereas 15 were in remission. Lumbar sympathetic blockade was 67% effective in the back pain cohort, 82% effective in the abdominopelvic pain cohort, and 75% effective in the leg pain cohort. Seventeen data points went on to neurolysis, two to neuromodulation, and eight to intrathecal pump implantation. Conclusions Lumbar sympathetic blockade is effective for back, abdominopelvic, and leg pain related to cancer and its treatments. Future research should be aimed at refining its role within multimodal pain management.

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Lumbar Sympathetic Neurolysis: How to and When to Use?

Cited by 19 publications

References 9 publications

Repeated Single Level Lumbar Sympathetic Neurolysis using Alcohol in a Plantar Hyperhidrosis Patient: A 5-year Follow-up Case Report

Repeated Single Level Lumbar Sympathetic Neurolysis using Alcohol in a Plantar Hyperhidrosis Patient: A 5-year Follow-up Case Report

Lumbar Sympathetic Block for Intractable Lower‐Limb Postherpetic Neuralgia: Report of Two Cases

The Use of L2 and L3 Lumbar Sympathetic Blockade for Cancer-Related Pain, an Experience and Recommendation in the Oncologic Population

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