Marada S, Punj J, Dhar A, Bhoi D, Mohan V, Trikha A, Pandey RK, Darlong V. To Assess Technical Feasibility of Ultrasound Lumbar Sympathetic Block with Electrical Stimulation Needle in Out of Plane Needle Orientation: A Prospective Interventional Study.
PAIN MEDICINE 2021;
23:873-877. [PMID:
34402914 DOI:
10.1093/pm/pnab258]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE
We describe technical feasibility of a new technique of ultrasound lumbar sympathectomy (ULS) validated by fluoroscopy.
DESIGN
Prospective interventional study.
SETTING
Pain block area.
SUBJECTS
Thirty patients of peripheral arterial disease (PAD) with rest pain numerical rating score (NRS) ≥ 3 were recruited.
METHODS
In lateral position, curved probe (FUJIFILM SonoSite Edge, 2-5 MHz) was placed transversely at iliac crest. An electrical stimulation needle was inserted out-plane, below lower pole of kidneys directed anterior to the vertebral body below. When needle tip was not visualized, current of 2.0 A was applied. Patients quadriceps contractions, ultrasound psoas contractions and bone contact guided needle placement and confirmed on fluoroscopy. Other parameters noted were: number of needle insertions, vertebral level, Pain NRS at baseline and at 4 hrs, 24 hrs, one week and two weeks post block, temperature rise and any other complications.
RESULTS
In all patients, needle tip was correctly placed in one to three attempts. In 73% patients, needle tip was at L3. Baseline Pain NRS was 8 (IQR 7-8) which decreased to 2 (IQR 2-3) at one week post-procedure and maintained at this range till 2 weeks later. Temperature rise of > 20C was noted in all patients.
CONCLUSION
ULS can safely be performed in patients of PAD by out-plane approach in lateral patient position with electrical stimulation needle. Before injection of drug, aspiration of blood should be ruled out in view of possibility of aortocaval injection.
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