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SNIS 9th annual meeting electronic poster abstracts
E-043 Image guided sympathetic blocks
  1. F Massari1,
  2. N Tsai2,
  3. Z Rumboldt1,
  4. A Pedicelli3,
  5. G Bonaldi4,
  6. A Cianfoni1
  1. 1Department of Radiology, Medical University of South Carolina, Charleston, South Carolina, USA
  2. 2Department of Physical Medicine and Rehabilitation, Medical University of South Carolina, Charleston, South Carolina, USA
  3. 3Department of Radiology, Catholic University of Rome, A.Gemelli Hospital, Rome, Italy
  4. 4Department of Neuroradiology, Riuniti Hospitals, Bergamo, Italy


Introduction/purpose Aim of this education exhibit is to offer an overview on image guided sympathetic blocks, focusing on specific indications and techniques, through the use of Fluoroscopy and/or CT imaging guidance, at each level of blockade.

Materials and Methods Sympathetic blocks are used for diagnostic, prognostic and therapeutic purposes for painful and other conditions associated with sympathetic system dysfunctions. Main indications for sympathetic blockade are: Complex regional pain syndrome (CRPS), phantom limb pain, central pain, hyperhydrosis, acute pancreatitis, and abdominal viscera cancer pain. Stellate ganglion blocks are utilized for painful and non-painful conditions related to sympathetic dysfunctions of head, neck and upper extremities. Thoracic sympathetic blocks are utilized for CRPS, postoperative analgesia, pain from fractured ribs, therapeutic control of hyperhydrosis of the upper limbs and torso, liver capsule pain after blunt trauma, acute postherpetic neuralgia, and premature ventricular contractions. Coeliac plexus blocks are utilized in pain due to intra-abdominal cancer, stemming from organs innervated by coeliac plexus. Lumbar sympathetic blocks are utilized for CPRS of the lower extremities, herpes zoster, amputation stump pain and inoperable peripheral vascular vasospastic diseases of the lower limb. Superior hypogastric blocks are utilized for pelvic pain, and pelvic organs cancer pain (uterus, cervix, bladder, prostate, urethra, testes and ovaries). Impar ganglion blocks are utilized in coccydynia.

Results The sympathetic nervous system has been implicated in numerous pain syndromes including neuropathic, vascular and visceral pain. In relation to this, in order to determine the sympathetic role in the transmission of pain and to manage these algic syndromes, sympathetic ganglia are targeted for local anesthetic blocks, for diagnostic, prognostic, and therapeutic purposes, balanced in a more complex pain treatment strategy, in the treatment of CRPS and other pain conditions. Safe and precise performance of these blocks requires knowledge of the loco-regional anatomy, accurate imaging guidance, and rigorous technique. Elements of relevant fluoroscopic and cross sectional anatomy, as well as procedural technique elements are discussed and displayed.

Conclusion This educational exhibit summarizes the indications, the anatomy and the techniques, under Fluoroscopy or CT guidance, for the sympathetic blocks.

Competing interests None.

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