The lumbar sympathetic plexus lies along the anterolateral aspect of the lumbar vertebral bodies from L2 to L5 (Figure 12.4A). To block this sympathetic chain ipsilaterally, the needle tip is placed along the anterior lateral aspect of the L2 vertebral body.
Indications for lumbar sympathetic plexus blockade include the following:
Reflex sympathetic dystrophy of the lower extremities Phantom limb pain (lower extremity)
Lower extremity pain from vascular insufficiency (e.g., chronic arterial emboli, Raynaud's disease) Lower extremity pain from gangrene, frostbite
Lower extremity hyperhydrosis and posttraumatic syndromes leading to pain and venous engorgement
Needle placement is accomplished with image guidance from either CT or fluoroscopy.2,6,7 A long (6-8 in.) 22- or 25-gauge needle is passed via an oblique route from posterior to anterior. The needle tip is positioned along the anterior lateral aspect of the L2 vertebra (Figure 10.4B). Injection of radiographic contrast (3 mL of Omnipaque 240 or equiva-
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This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.