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Continuous lumbar sympathetic block.

P Petriccione di Vadi¹, W Hamann

¹Department of Anaesthetics, Guy's Hospital, London, England.

The Clinical Journal of Pain

|September 1, 1991

Summary

A reversible lumbar sympathetic block effectively relieved rest pain in a patient with peripheral vascular disease. This temporary relief paved the way for a successful chemical lumbar sympathectomy, offering sustained pain management.

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Area of Science:

Vascular Surgery
Pain Management
Neurology

Background:

Peripheral vascular disease (PVD) can cause severe limb pain, including rest pain and intermittent claudication.
Chemical lumbar sympathectomy is a treatment option for PVD pain, but carries risks like leg edema, especially with venous congestion.

Observation:

A 74-year-old woman with PVD experienced rest pain in her right big toe and claudication.
Venous congestion presented a contraindication for immediate chemical lumbar sympathectomy due to increased edema risk.

Findings:

A continuous lumbar sympathetic block using local anesthetic provided complete, temporary pain relief in the affected toe.
The reversible block demonstrated safety and efficacy, with no observed side effects.
Following the successful block, a chemical lumbar sympathectomy was performed, yielding pain relief for four weeks.

Implications:

Continuous lumbar sympathetic blocks offer a safe, reversible alternative for assessing treatment response before irreversible procedures.
This approach may help select appropriate candidates for chemical lumbar sympathectomy, optimizing outcomes in PVD pain management.
Further research could explore the long-term efficacy and patient selection criteria for this two-stage treatment strategy.

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