Lumbar Sympathetic Blockade

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

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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Essentials of Human Physiology

Essentials of Human Physiology

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