L2

d 228

Figure 12.4. Continued. (E) Lateral radiograph after injection of 3 mL of radiographic contrast medium (arrowheads). The contrast material spreads along the margin of the vertebra, and there is no sign of vascular filling. It is now safe to inject the local anesthetic for the sympathetic block.

Parenteral Injection Contrast Medium

lent) is used to confirm needle tip position and to ensure the absence of any vascular communication (Figure 12.4C-E). Injection of 10 to 20 mL of bupivacaine 0.25% will provide temporary relief. (This procedure may need to be repeated weekly for several weeks for reflex sympathetic dystrophy.) Administration of 10 mL of absolute alcohol (or 6% phenol) will provide permanent neurolysis, again with general anesthesia.

The risks of lumbar sympathetic blockades include intravascular injection into the aorta or inferior vena cava (which may lead to neurological or cardiac toxicity), ureteral injury, and bleeding. Psoas necrosis and visceral perforation have also occurred.

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Essentials of Human Physiology

Essentials of Human Physiology

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