Lumbar Sympathetic Ganglion Block
Lumbar Sympathetic Ganglion Block is an interventional pain procedure. Procedure is performed to achieve long term pain relief of 4 to 6 months or longer.
Ganglion Block is indicated for following diseases
- Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy (RSD).
- Diabetic neuropathy.
- Peripheral Vascular Disease.
- Phantom Pain.
- Post-herpetic neuralgia involving the lower extremities.
Ganglion Block is performed by interventional pain specialist. Procedure is performed under mild to moderate sedations. Patient is advised to lie in prone position on X-ray compatible surgical table. ‘Flex prone position’ is maintained by placing pillow under abdomen. Patient if unable to tolerate ‘Flex prone position’ then procedure is performed in curled lateral position.
Skin Preparation: Surgical area of lumbar vertebrae 2,3 and 4 is identified by using X-ray image. Skin area where needle will be penetrating is marked with marking pen. The skin is prepped with antiseptic solution as suggested by surgical center and joint commission.
Numbing of Skin and Subcutaneous tissue:The skin area that was marked for needle penetration is anesthetized to numb with a local anesthetic. Local anesthetics used are lidocaine 0.5% or 1%.
Needle Placement: Lumbar sympathetic ganglions are located over antero-lateral surface of vertebral bodies of L2,3 and 4 lumbar vertebrae. All three or 2 ganglion may be block depending on indications for procedure. Lumbar vertebrae 2, 3 and 4 are identified using X-ray. Marking pen is used to mark entry point of needle about 3-inch lateral from midline at the level of L2, 3 and or 4th lumbar vertebrae. After local anesthesia 22 G spinal is placed near anterolateral surface of body of lumbar vertebrae under fluoroscopic guidance. Needle location is confirmed with fluoroscopy using oblique, lateral and antero-posterior view. Dye is injected and linear spread of dye in cephalic and caudal direction is confirmed using fluoroscopy in different plane. Local anesthesia lidocaine is injected as a test dose, if needle tip is in blood vessels then needle is repositioned. Dye study may need to be repeated. Once needle tip is confirmed at right position then medications are injected in volume of 4 to 6 cc at each level. Procedure may take 30 to 45 minutes.