Mustafa Yemliha AYHAN, Saziye Sahin, Erkan Yavuz AKÇABOY, Hamit GÖKSU, Samet Sancar KAYA, Şeref ÇELİK

Semptomatik Periferik Arter Hastalarında Lomber Sempatik Bloğun Ağrı Üzerine Etkisi-Retrospektif Analiz

Amaç: Alt ekstremitenin kronik iskemik hastalığı olan hastalarda, lokal anestezik ve steroid karışımı ile uygulanan lomber sempatik blokajın (LSB) ağrı üzerine etkisinin araştırılması. Yöntem: Floroskopi eşliğinde L2 ve L4 seviyelerinden 8 mg deksametazon, 80 mg %2 lidokain ve 4 mL salin karışımı kullanılarak LSB uygulanan 23 hasta retrospektif olarak incelendi. Vizüel Analog Skala (VAS) değerleri blokaj öncesi ve blokajdan 3 gün, 1 ve 3 ay sonra kaydedildi. Bulgular: Çalışmaya 20 (%87) erkek ve 3 (%13) kadın hasta dahil edildi. Hastaların yaş ortalaması 59,65±13,33 yıl idi. Hastaların blokaj sonrası 3. gün, 1. ve 3. ay VAS skorları başlangıç VAS skorlarından anlamlı derecede düşüktü (p

Effect of the Lumbar Sympathetic Block on Pain in Patients with Symptomatic Peripheral Arterial Disease-Retrospective Analysis

Objective: To study the effect of lumbar sympathetic block (LSB) with a mixture of local anesthetics and steroids on pain in patients with chronic ischemic lower limb disease. Methods: Retrospectively 23 patients were reviewed with peripheral arterial disease who underwent LSB using a mixture of 8 mg of dexamethasone, 80 mg of 2% lidocaine, and 4 mL of saline at 2 levels, L2 and L4, under the guidance of fluoroscopy. Recordings of the Visual Analog Scale (VAS) scores at 3 days before the blockage, and 1 month and 3 months after treatment were obtained. Results: The study included 20 (87%) male and 3 (13%) female patients. The mean age of the patients was 59.65±13.33 years. The patients’ post-blockage 3rd day, and 1st and 3rd month VAS scores were significantly lower than the baseline VAS scores (p

PDF

___

1. Aronow WS. Peripheral arterial disease of the lower extremities. Arch Med Sci 2012;8(2):375.
2. Karabay Ö, Karaçelik M, Yılık L, et al. İskemik periferik arter hastalığı: Bir tarama çalışması. Turk Gogus Kalp Damar Cerrahisi Derg 2012;20(3):450-7.
3. Rabia K, Khoo EM. Peripheral arterial disease in general and diabetic population. Med J Malaysia 2007;62(2):182-5.
4. Garcia LA. Epidemiology and pathophysiology of lower extremity peripheral arterial disease. J Endovasc Ther 2006;13(2):3-9.
5. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45(1):5- 67.
6. Setacci C, De Donato G, Teraa M, et al. Chapter IV: Treatment of critical limb ischaemia. Eur J Vasc Surg 2011;42 Suppl 2:43- 59.
7. Araujo JD, Araujo Filho JD, Ciorlin E, et al. Células-tronco de medula óssea em isquemia crítica de membros. Rev Bras Hematol Hemoter 2009(1);31:128-39.
8. Bendermacher B, Willigendael E, Teijink J, Prins M. Medical management of peripheral arterial disease. J Thromb Haemost 2005;3(8):1628-37.
9. Löfström B, Quist SZ. Lumbar sympathetic blocks in the treatment of patients with obliterative arterial disease of the lower limb. Int Anesthesiol Clin 1969;7(2):423-38.
10. Kanao-Kanda M, Kanda H, Iida T, Kikuchi S, Azuma N. Clinical application of laser speckle flowgraphy to assess changes in blood flow to the foot after a lumbar sympathetic ganglion block: A case report. J Pain Res 2021;14:1451-6.
11. Singh R, Kulkarni R, Kulkarni K, Chavannavar K. Evaluation of the radiofrequency ablation of lumbar sympathetic ganglia in lower limb ischemic ulcers in indian population: Radiofrequency ablation and lower limb ischemic ulcers. Int J Med Surg Sci 2021;8(2):1-9.
12. Barreto Junior EPdS, Nascimento JDS, Castro APCRd. Neurolitic block of the lumbar sympathetic chain improves chronic pain in a patient with critical lower limb ischemia. Braz J Anesthesiol 2018;68(1):100-3.
13. Kulkarni KR, Kulkarni RM. Study of chemical neurolysis, radiofrequency ablation and combined radiofrequency with chemical neurolysis of lumbar sympathetic ganglion in peripheral vascular diseases of the lower limbs. Glob J Anes & Pain Med 2020;3(2):272-80.
14. Rossi M, Carpi A. Skin microcirculation in peripheral arterial obliterative disease. Biomed Pharmacother 2004;58(8):427- 31.
15. Charkoudian N, Eisenach JH, Atkinson JL, Fealey RD, Joyner MJ. Effects of chronic sympathectomy on locally mediated cutaneous vasodilation in humans. J App Physiol 2002;92(2):685-90.
16. Cheng J, Daftari A, Zhou L. Sympathetic blocks provided sustained pain relief in a patient with refractory painful diabetic neuropathy. Case Rep Anesthesiol 2012:285328.
17. Karanth VK, Karanth TK, Karanth L. Lumbar sympathectomy techniques for critical lower limb ischaemia due to nonreconstructable peripheral arterial disease. Cochrane Database Syst Rev 2016;12(12):CD011519.
18. Naghipour B, Aghamohamadi D, Azarfarin R, et al. Dexamethasone added to bupivacaine prolongs duration of epidural analgesia. Middle East J Anesthesiol 2013;22(1):53-7.
19. Pehora C, Pearson AM, Kaushal A, Crawford MW, Johnston B. Dexamethasone as an adjuvant to peripheral nerve block. Cochrane Database Syst Rev 2017;11(11):CD011770.
20. Haywood A, Good P, Khan S, et al. Corticosteroids for the management of cancer related pain in adults. Cochrane Database Syst Rev 2015;2015(4):CD010756.
21. Vyvey M. Steroids as pain relief adjuvants. Can Fam Physician 2010;56(12):1295-7.
22. Holiday F, Barendregt W, Slappendel R, Crul B, Buskens F, Van der Vliet J. Lumbar sympathectomy in critical limb ischaemia: surgical, chemical or not at all? Cardiovasc Surg 1999;7(2):200-2.
23. Chahal A, Malla S, Sharma S, Chumber S, Madhusudhan KS. CT-guided lumbar sympathectomy as a last option for chronic limb-threatening ischemia of the lower limbs: Evaluation of technical factors and long-term outcomes. AJR Am J Roentgenol 2021;216(5):1273-82.
24. Verma YS, Thakur J, Sodhi SS. Evaluation of chemical lumbar sympathectomy for chronic arterial ischaemia of lower limb(s). J Anaesthesiol Clin Pharmacol 2007;23(4):391-4.
25. Ozturk EC, Sencan S, Gunduz OH. Lumbar sympathetic block for intractable lower limb postherpetic neuralgia: Report of two cases. Pain Pract 2021;21(3):353-6.
26. Lee HM, Weinstein JN, Meller ST, Hayashi N, Spratt KF, Gebhart GF. The role of steroids and their effects on phospholipase A2: An animal model of radiculopathy. Spine 1998;23(11):1191-6.
27. Johansson A, Bennett GJ. Effect of local methylprednisolone on pain in a nerve injury model: A pilot study. Reg Anesth Pain Med 1997;22(1):59-65.
28. Devor M, Govrin-Lippmann R, Raber P. Corticosteroids suppress ectopic neural discharge originating in experimental neuromas. Pain 1985;22(2):127-37.
29. Alexander CE, De Jesus O, Varacallo M. Lumbar Sympathetic Block. Treasure Island (FL): StatPearls Publishing, 2022. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK431107/