Lumbar sympathetic blocks for complex regional pain syndrome

: Case Report
Mukri P. Nasution* ;Erikman Siregar* ;Soni Sunarso Sulistiawan** ; Dedi Susila** ;Arie Utariani** ;Nancy Margarita Rehatta#
* Resident, Department of Anesthesiology and Reanimation, Faculty of Medicine Airlangga University, Dr. Soetomo Hospital Surabaya, Indonesia
**Consultant, Department of Anesthesiology and Reanimation, Faculty of Medicine Airlangga University, Dr. Soetomo Hospital Surabaya, Indonesia
# Professor, Consultant, Department of Anesthesiology and Reanimation, Faculty of Medicine Airlangga University, Dr. Soetomo Hospital Surabaya, Indonesia

BACKGROUND RESULT
Complex regional pain Syndrome ( CRPS) is usually triggered by a Age Weight VAS Preop VAS Post Duration of
traumatic event of the soft tissue involving the nervous tissue. Lumbar (years) (kg) procedure Procedure (Minutes)
sympathetic blocks should be used cautiously in clinical practice,in
carefully selected patients, and probably only after failure of other Patient 1 72 70 8-9 1-2 40
treatment options. Patient 2 70 67 8-9 1-2 45
Table 1. Summary of Parameters value

OBJECTIVE
To present a serial case with complex regional pain syndrome treated
with lumbar sympathetic blocks.

CASE REPORT

Fg 5 :Case 1 post lumbar sympathetic Fg 6 :Case 2 post lumbar sympathetic

Fg 1 :Case 1 Fg 1 :Case 2

A 72 year old woman ,70 kg with painful

A 70 year old woman, 67 kg with a Fg 7 : lower extremity was Fg 8 : 30-days post-lumbar symphatetic Fg 9 : 120-days post-lumbar
leg, nearly constant swelling, stifness, symphatetic
history of uncontrolled Type II diabetes revascularized
skin colour changes in her leg. decreased
.history of enlarging heel ulcer
range of motion, and an inability to bear
swelling, stiffness and burning. VAS 8-9
DISCUSSION
weight without severe pain. VAS 8-9 . not
respond to medication. History of burns
in 2002. There are a lot of kind of CRPS treatment such as Corticosteroids, calcium-
regulating drugs, opioids, NSAIDs, sodium channel blocking agents,
MATERIALS AND METHODS gabapentin, clonidine, block sympathetic, surgical and psychological therapy.
Sympathetic denervation produces arterial and arteriolar vasodilation.
This technique should only be used in centre where Regional
Subjects Anaesthesiologist available to ensure expert review and patient safety.
2 Patients; 70 and 72 years-old; with complex lumbar sympathetic blocks provides an excellent relief of patients in this case
regional pain syndrome ; VAS 8-10 series
Intervention
C-arm in AP position with X-ray tube under
patient CONCLUSION
Single puncture at L2, L3 and L4.
Needle quincke 22 gauge
In this serial case a lumbar sympathetic blocks is an effective pain
Confirm the needle position on the AP, Fg 3 : Disinfection of injection
oblique and lateral views. area control methode in patient with complex regional pain syndrome ,
Negative aspiration, inject iohexol 2 mL minimally invasive, fast and safe procedure.
Sensory stimulation is performed at The lower extremity was subsequently revascularized
frequencies 50 Hz and 0.6 V accelerate wound healing on patient with ulcus
Motor stimulation is done with frequency 2
HZ with 2 V
Inject the depotmedrol and unplug the REFERENCES
needle
1 Brown DL. Lumbar Sympathetic Block. Atlas of Regional Anesthesia. 4th Edn; Philadelphia,; 2010.
Agent 2 Hadzic A-The New York School of Regional Anesthesia : Text book of regional anesthesia and acut pain management, new
Inject 1% lignocaine 2 ml and wait 2 minutes York, McGrawhill Medical, 2007.
3 Harden RN, Bruehl S, Perez RS et al. Validation of proposed diagnostic criteria (the Budapest Criteria) for complex
Inject 5-10 ml of alcohol 50-100% or phenol 6- Fg 4 :fluoroscopic spread of
contrast in typical lumbar regional pain syndrome.Pain 2010.
10% sympathetic block. 4 Prithvi Raj P. Textbook of regional Anesthesia. Texas : Texas Tech University Health Sciences Center School of Medicine;
2003.