Sympathetic Nerve Blocks

Sympathetic nervous system is organized at various levels in the body innervating organs and multiple structures. Visceral organs are supplied by sympathetic plexus like celiac plexus, hypogastric plexus, and ganglion impar. Upper limb and head are supplied by stellate ganglion, while lower limb is supplied by lumbar sympathetic chain. Blocks of these fibres can alleviate pain conditions and other conditions associated with sympathetic activity. Cancer pain is now commonly treated with visceral sympathetic plexus blocks with reasonable success, improving the quality of life in these patients. Chronic regional pain syndrome and peripheral vascular diseases can be effectively managed with stellate or lumbar sympathetic blocks. Proper understanding of anatomy and steps for conduct of these minimally invasive percutaneous interventions is required for precise placement of blocks. Use of fluoroscopy and ultrasound helps in improving efficacy of these blocks by improving success rate and minimizing complications. Long-lasting relief can be provided by destruction of these sympathetic plexus with chemical neurolysis or radiofrequency ablation.