Ultrasound-Guided Lumbar Sympathetic Ganglion Blockade Using Shamrock Method: A Prospective Case Series

Abstract

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.