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Percutaneous lumbar sympathetic plexus catheter placement for short- and long-term pain relief: CT technique and
R J Wechsler1, E D Frank, E H Halpern
1Department of Radiology, Thomas Jefferson University Hospital and Medical College, Philadelphia, PA 19107, USA.
Purpose:
The purpose of this work was to evaluate the use of percutaneously placed lumbar sympathetic plexus catheter placement under CT guidance in patients with complex regional pain syndrome (CRPS) or nonspecified neuropathic pain (NP) of the lower extremity.
Method:
Sixteen lumbar sympathetic plexus catheter placements were performed in seven patients with CRPS and seven patients with NP. A 19 gauge epidural catheter was placed anterior to the psoas muscle at the L2-3 level. Twenty-five to 840 mg of bupivacaine hydrochloride per day was administered for a 1 to 8 day duration.
Results:
In CRPS patients, there was complete short-term pain relief in one patient, considerable in four, mild in one, and none in one. There was total long-term pain relief in one patient and considerable long-term pain relief in three. In three patients, there was enduring pain relief at last follow-up. In NP patients, the procedure yielded considerable short-term pain relief in four, mild in two, and none in one. There was no enduring long-term in any of these patients. A retroperitoneal abscess developed in one patient and resolved on intravenous antibiotics without sequelae.
Conclusion:
Percutaneous lumbar sympathetic plexus catheter placement is easily performed, achieves short-term pain relief in the majority of patients, and may prove effective in long-term pain relief of CRPS patients.