Lumbar Sympathetic Block and Sympatholysis

Lumbar sympathetic ganglion block is a widely used treatment for patients with complex regional pain syndrome (CRPS) in their lower extremities. Lumbar sympathetic blocks are also performed for various other painful conditions resulting in circulatory insufficiency in the lower extremities such as Buerger’s disease, embolic occlusions, frostbite, vasospastic disease, peripheral arterial disease, phantom limb pain, hyperhidrosis, and postherpetic neuralgia. Lumbar sympathetic blocks are one of the earliest descriptions in interventional pain management since the early 1900s. The first reports of a lumbar sympathetic block technique, as well as sympatholysis, were initially documented in the 1920s. Procedural techniques have evolved with the common utilization of fluoroscopy not only with lumbar sympathetic blocks with local anesthetic, but also with various approaches to perform neurolysis. In providing sympatholysis, the procedure specifically seeks to accomplish a long-term or permanent disruption of the sympathetic chain output to the lower extremity in comparison to the local anesthetic sympathetic block when the relief with local anesthetic is not long lasting. This chapter provides an overview of lumbar sympathetic blocks with anatomy, physiology, indications, contraindications, complications, and technical aspects to improve outcomes and reduce adverse effects.