Lumbar Sympathetic Block: Fluoroscopy

2016 ◽  
Author(s):  
Samer N. Narouze
Keyword(s):  
Pain Syndrome ◽  
Diagnostic Value ◽  
Lateral Approach ◽  
Direct Result ◽  
Sympathetic Blockade ◽  
Sympathetic Block ◽  
Sympathetically Maintained Pain ◽  
Therapeutic Value ◽  
Classic Approach ◽  
Sympathetic Blocks

Lumbar sympathetic blocks (LSB) result in the interruption of the sympathetic efferent fibers to the lower extremities with sparing of the somatic nerves, thus providing a diagnostic value as to the relative sympathetic contribution to the patient’s pain syndrome. In those patients with significant sympathetically maintained pain, repeated blocks may provide a therapeutic value and help facilitate physical therapy. The original described technique is the paramedian or “classic” approach described by Mandl in 1926. A more lateral approach was later developed by Reid and colleagues. The incidence of complications related to lumbar sympathetic blockade is minimal. The complications result either from insertion and manipulation of the needle or as a direct result of the injected solution.

scholarly journals Local Anesthetic Sympathectomy Restores fMRI Cortical Maps in CRPS I after Upper Extremity Stellate Blockade: A Prospective Case Study

2014 ◽  
Vol 5;17 (5;9) ◽  
pp. E637-E644
Author(s):  
Dr. Elena K. Enax-Krumova
Keyword(s):  
Pain Relief ◽  
Pain Intensity ◽  
Case Series ◽  
Pain Syndrome ◽  
Cortical Reorganization ◽  
Type I ◽  
Cortical Representation ◽  
Sympathetic Block ◽  
Sympathetically Maintained Pain ◽  
Cortical Maps

Background: Patients with complex regional pain syndrome type I (CRPS I) show a cortical reorganization with contralateral shrinkage of cortical maps in S1. The relevance of pain and disuse for the development and the maintenance of this shrinkage is unclear. Objective: Aim of the study was to assess whether short-term pain relief induces changes in the cortical representation of the affected hand in patients with CRPS type I. Study Design: Case series analysis of prospectively collected data. Methods: We enrolled a case series of 5 consecutive patients with CRPS type I (disease duration 3 – 36 months) of the non-dominant upper-limb and previously diagnosed sympathetically maintained pain (SMP) by reduction of the pain intensity of more than > 30% after prior diagnostic sympathetic block. We performed fMRI for analysis of the cortical representation of the affected hand immediately before as well as one hour after isolated sympathetic block of the stellate ganglion on the affected side. Statistics: Wilcoxon-Test, paired t-test, P < 0.05. Results: Pain decrease after isolated sympathetic block (pain intensity on the numerical rating scale (0 – 10) before block: 6.8 ± 1.9, afterwards: 3.8 ± 1.3) was accompanied by an increase in the blood oxygenation level dependent (BOLD) response of cortical representational maps only of the affected hand which had been reduced before the block, despite the fact that clinical and neurophysiological assessment revealed no changes in the sensorimotor function. Limitations: The interpretation of the present results is partly limited due to the small number of included patients and the missing control group with placebo injection. Conclusions: The association between recovery of the cortical representation and pain relief supports the hypothesis that pain could be a relevant factor for changes of somatosensory cortical maps in CRPS, and that these are rapidly reversible. Key words: Cortical reorganization, cortical plasticity, cortical maps, complex regional pain syndrome (CRPS), sympathetically maintained pain (SMP), sympathetic block (SB)

Sympathetic nervous system and pain: A clinical reappraisal

1997 ◽  
Vol 20 (3) ◽  
pp. 426-434 ◽  
Author(s):  
Helmut Blumberg ◽  
Ulrike Hoffmann ◽  
Mohsen Mohadjer ◽  
Rudolf Scheremet
Keyword(s):  
Spontaneous Pain ◽  
Sympathetic Block ◽  
Technical Success ◽  
Sympathetically Maintained Pain ◽  
Sympathetic Function ◽  
Target Article ◽  
Autonomic Motor ◽  
The Relationship ◽  
Generalized Distribution ◽  
Sympathetic Blocks

The target article discusses various aspects of the relationship between the sympathetic system and pain. To this end, the patients under study are divided into three groups. In the first group, called “reflex sympathetic dystrophy” (RSD), the syndrome can be characterized by a triad of autonomic, motor, and sensory symptoms, which occur in a distally generalized distribution. The pain is typically felt deeply and diffusely, has an orthostatic component, and is suppressed by the ischemia test. Under those circumstances, the pain is likely to respond to sympatholytic interventions. In a second group, called “sympathetically maintained pain” (SMP) syndrome, the principal symptoms are spontaneous pain, which is felt superficially and has no orthostatic component, and allodynia. These symptoms, typically confined to the zone of a lesioned nerve, may also be relieved by sympathetic blocks. Since the characteristics of the pain differ between RSD and SMP, the underlying kind of sympathetic–sensory coupling may also vary between these cases. A very small third group of patients exhibits symptoms of both RSD and SMP. The dependence or independence of pain on sympathetic function reported in most published studies seems to be questionable because the degree of technical success of the block remains uncertain. Therefore, pain should not be reported as sympathetic function independent until the criteria for a complete sympathetic block have been established and satisfied.

scholarly journals Fibreoptic Bronchoscopy in the Critically Ill: A Prospective Study of its Diagnostic and Therapeutic Value

1992 ◽  
Vol 20 (4) ◽  
pp. 464-469 ◽  
Author(s):  
R. Bellomo ◽  
E. Tai ◽  
G. Parkin
Keyword(s):  
Prospective Study ◽  
Critically Ill ◽  
Lower Lobe ◽  
Major Complication ◽  
Diagnostic Value ◽  
Fibreoptic Bronchoscopy ◽  
Clinical Assessments ◽  
Therapeutic Value ◽  
Before And After ◽  
A Prospective Study

Aim A prospective study was undertaken to assess the diagnostic value and therapeutic usefulness of fibreoptic bronchoscopy in the critically ill. Method Fifty-six bronchoscopies were performed in fifty patients. Biochemical, radiological, microbiological and clinical assessments were made before and after each procedure. Results Eighteen fibreoptic bronchoscopies were performed for therapeutic indications (32.1%) of which ten (55.6%) yielded a useful outcome. Thirty-eight bronchoscopies were for diagnostic purposes (67.8%) of which 22 (5 7.9%) were clinically useful. Broncho-alveolar lavage was performed in twenty-eight cases (50%) and it led to a clinically useful diagnosis in 17 (60.7%). There was no major complication. A subgroup of patients was defined (persistent left lower lobe collapse or consolidation following thoracic or abdominal surgery) in whom fibreoptic bronchoscopy usually did not yield a useful outcome. Conclusion The use of fibreoptic bronchoscopy in the Intensive Care Unit, in combination with the technique of broncho-alveolar lavage, results in a clinically useful outcome in the majority of cases. Fibreoptic bronchoscopy is an effective and safe diagnostic and therapeutic tool in critically ill patients.

Single-Needle Lateral Approach for Lumbar Sympathetic Block

1975 ◽  
Vol 54 (6) ◽  
pp. 725???729 ◽  
Author(s):  
ELI M. BROWN ◽  
VIMALA KUNJAPPAN
Keyword(s):  
Lateral Approach ◽  
Sympathetic Block

scholarly journals Local anaesthetic sympathetic blockade for complex regional pain syndrome

2016 ◽  
Author(s):  
Neil E O'Connell ◽  
Benedict M Wand ◽  
William Gibson ◽  
Daniel B Carr ◽  
Frank Birklein ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Local Anaesthetic ◽  
Pain Syndrome ◽  
Sympathetic Blockade

Lumbar Sympathetic Blocks Speed Early and Second Stage Induced Labor in Nulliparous Women 

1999 ◽  
Vol 90 (4) ◽  
pp. 1039-1046 ◽  
Author(s):  
Barbara L. Leighton ◽  
Stephen H. Halpern ◽  
Donna B. Wilson
Keyword(s):  
Epidural Analgesia ◽  
Cesarean Delivery ◽  
Delivery Mode ◽  
Sympathetic Block ◽  
Cervical Dilation ◽  
Induced Labor ◽  
Second Stage ◽  
Vaginal Deliveries ◽  
Epidural Catheters ◽  
Sympathetic Blocks

Background Rapid cervical dilation reportedly accompanies lumbar sympathetic blockade, whereas epidural analgesia is associated with slow labor. The authors compared the effects of initial lumbar sympathetic block with those of epidural analgesia on labor speed and delivery mode in this pilot study. Methods At a hospital not practicing active labor management, full-term nulliparous patients whose labors were induced randomly received initial lumbar sympathetic block or epidural analgesia. The latter patients received 10 ml bupivacaine, 0.125%; 50 microg fentanyl; and 100 microg epinephrine epidurally and sham lumbar sympathetic blocks. Patients to have lumbar sympathetic blocks received 10 ml bupivacaine, 0.5%; 25 microg fentanyl; and 50 microg epinephrine bilaterally and epidural catheters. Subsequently, all patients received epidural analgesia. Results Cervical dilation occurred more quickly (57 vs. 120 min/cm cervical dilation; P = 0.05) during the first 2 h of analgesia in patients having lumbar sympathetic blocks (n = 17) than in patients having epidurals (n = 19). The second stage of labor was briefer in patients having lumbar sympathetic blocks than in those having epidurals (105 vs. 270 min; P &lt; 0.05). Nine patients having lumbar sympathetic block and seven having epidurals delivered spontaneously, whereas seven patients having lumbar sympathetic block and seven having epidurals had instrument-assisted vaginal deliveries. Cesarean delivery for fetal bradycardia occurred in one patient having lumbar sympathetic block. Cesarean delivery for dystocia occurred in five patients having epidurals compared with no patient having lumbar sympathetic block (P = not significant). Visual analog pain scores differed only at 60 min after block. Conclusions Nulliparous parturients having induced labor and receiving initial lumbar sympathetic blocks had faster cervical dilation during the first 2 h of analgesia, shorter second-stage labors, and a trend toward a lower dystocia cesarean delivery rate than did patients having epidural analgesia. The effects of lumbar sympathetic block on labor need to be determined in other patient groups. These results may help define the tocodynamic effects of regional labor analgesia.

Thoracic sympathetic block for the treatment of complex regional pain syndrome type I: A double-blind randomized controlled study

Pain ◽  
2014 ◽  
Vol 155 (11) ◽  
pp. 2274-2281 ◽  
Author(s):  
Roberto de Oliveira Rocha ◽  
Manoel Jacobsen Teixeira ◽  
Lin Tchia Yeng ◽  
Mirlene Gardin Cantara ◽  
Viviane Gentil Faria ◽  
...  
Keyword(s):  
Complex Regional Pain Syndrome ◽  
Pain Syndrome ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Type I ◽  
Syndrome Type ◽  
Sympathetic Block ◽  
Double Blind ◽  
Randomized Controlled
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