- Sympathetic blocks
- Rationale
- Vascular pain
- Origins of pain are complex. SNS block can improve circulation
- Neuropathic pain
- NeP may be sympathetically mediated, though pain is neve fully relieved
- Indications
- PVD
- Acute vascular disorders
- Eg thiopental injection
- Arterial occlusion
- Chronic vascular disorders
- Chronic vasospastic conditions (eg Raynauds)
- Chronic obliterates disease (Burger's)
- Visceral pain
- Upper abdominal cancers
- Rectal tenesmus
- Chronic pancreatitis
- Perianal cancers
- Cardiac pain
- Hyperhidrosis
- NeP
- Herpes zoster
- Carcinomatous neuropathy
- CRPS I & II
- Types of sympathetic block
- Diagnostic blocks
- Prognostic blocks
- Therapeutic blocks
- LA
- Neurolytic drugs (alcohol, phenol)
- Neuroablative (RF)
- Drugs
- IV regional sympathetic blocks
- Guanethidine blocks reuptake of NA and depletes stores in post ganglionic nerve terminals
- Coeliac plexus block
- Patient prone
- Needle entry just below 12th rib
- X-ray guidance in 2 planes
- Needle advanced until hits side of L1
- Needle withdrawn and advanced anterior to the coeliac plexus
- Complications
- Bleeding
- Retroperitoneal haematoma
- Intrathecal injection
- Paraplegia
- Pneumothorax
- Infection
- Hypotension
- Impotence
- Sympathetic blocks
- Sphenopalatine ganglion
- Cluster HA, migraine, atypical facial pain
- Stellate ganglion
- Pain of upper limb/thorax, vascular insufficiency
- Thoracic sympathetic chain
- Cancer pain of abdomen, thorax, head and neck
- Coeliac plexus
- Upper abdominal cancers, chronic pancreatitis
- Lumbar sympathectomy
- Vascular insufficiency, CRPS I/II, Neuropathic lower limb pain, rectal tenesmus
- Superior hypogastric plexus
- Cancer and non-cancer pelvic pain
- Ganglion of impar
- Perineal pain, coccydynia
- CEACCP
Link:ceaccp.oxfordjournals.org/content/10/3/88.full.pdf