Patient Xu, male, 80 years old, had ischemic pain in the left lower extremity for 2 months, necrotic ulceration of the fourth toe of the left foot for 2 weeks, atrophy of the left calf, VAS score 5-8. The patient’s pain persisted after amputation of the fourth toe of the left foot, and necrosis of the third toe appeared at the same time. On examination: painful face, shortness of breath, high blood pressure, rapid heart rate, lower skin temperature of the left lower extremity than the right lower extremity, and extremely weak pulsation of the dorsal artery of the left foot. The skin of the first and second toes of the left foot was slightly darkened, and the third toe was necrotic, after the amputation of the fourth toe. On the same day, a CT-guided lumbar sympathetic ganglion block was performed, and 1% Lidocaine 15 ml was administered. 5 minutes later, the skin temperature of the affected side rose rapidly, and the patient felt a marked reduction in pain, while respiration gradually stabilized and blood pressure decreased significantly. The analgesic pump was connected and the block was continued. After returning to the ward, the skin temperature was measured at 36.5 degrees in the left lower limb and 35.5 degrees in the right lower limb. The left dorsalis pedis artery pulsation was obvious. The patient was completely pain-free on the second day after the operation. He felt that he recovered strength quickly and had a good appetite. After one week of continuous block, the patient had significantly reduced pain, VAS 0-4 score, increased elasticity of the skin of the left lower leg, no significant difference from the right lower limb, and lighter skin color of the 1st and 2nd toes of the left foot. Proposed to perform anhydrous alcohol lumbar sympathetic ganglion disruption.
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