Lumbar sympathetic ganglion block Application Anatomy The lumbar sympathetic ganglion, located on the anterolateral side of the vertebral body of the spine, generally has four on each side, and is connected to the lumbar sympathetic trunk by intersegmental branches, superiorly to the thoracic sympathetic trunk; inferiorly between the anterolateral side of the lumbar vertebral body and the psoas major muscle, entering the pelvis through the posterior aspect of the common iliac vessels and connecting to the pelvic sympathetic trunk; the right side is located lateral to or partially covered by the inferior vena cava; the left side is located lateral to the abdominal aorta. It is closer to the median line than the sympathetic trunk of the thorax. Its branches are 1) the lumbar nerve, which is connected by the gray traffic branch and distributed with the lumbar plexus nerve; 2) the lumbar visceral nerve, which passes through the preganglionic fibers of the lumbar sympathetic ganglion. The paravertebral nodes of lumbar 1~2 join the abdominal aortic plexus and end at the inferior mesenteric ganglion, where the converted neurons send out postganglionic fibers that climb the inferior mesenteric artery and are distributed. The paravertebral nodes of lumbar 3~4 join the inferior epigastric plexus, and here the ganglia switch neurons and postganglionic fibers are distributed to the alimentary canal and pelvic organs below the left curvature of the colon, and there are fibers with vascular distribution to the lower extremities. Operative technique The operative technique of lumbar sympathetic ganglion block should be performed under the guidance of an imaging monitor. Body surface positioning: The patient is placed in the upward lateral position on the punctured side, and the superior margin of the corresponding punctured spine is determined. 6~8 cm of the median line is opened for local anesthetic mound and infiltrated layer by layer. A 12-cm-long, 7-gauge puncture needle is inserted at an angle of 60 degrees to the skin and directed toward the midline of the spine. The needle tip may touch the transverse process of the lumbar 1 vertebral body by advancing about 3~4 cm or the lateral edge of the vertebral body by advancing 6~7 cm. The position of the puncture needle is shown by the image monitor, and the direction and depth of the puncture needle advancement are again adjusted until it is confirmed that the needle tip touches the sympathetic ganglion of the anterolateral aspect of the vertebral body without looking for foreign sensation. Injection of contrast agent was seen to show a linear distribution of images next to the vertebral body, which did not move with the abdominal organs. The air resistance disappearance test for injection is positive, there is no blood and no cerebrospinal fluid in the retraction, and the patient can feel a feverish sensation in the abdominal cavity when 8~10ml of local anesthetic is injected. After the injection of the drug, the affected side is taken to the upward lateral position in order to make the drug dip to the location where the lumbar sympathetic ganglion is located. If the patient requires long-term treatment with this method, after successful puncture, an extra-membranous catheter is placed and a continuous lumbar sympathetic block can be performed. Indications For pain-based disorders including renal colic, sympathetic neuropathic pain (SMP) such as burning neuralgia, phantom limb pain, etc. For the treatment of vasospastic diseases such as Raynaud’s disease; thrombo-occlusive vasculitis (Buerger’s), diabetic peripheral neuralgia, ischemic necrosis, lower limb ulcers, post-frostbite pain, etc. It is also used to dilate blood vessels in the lower extremities, increase peripheral flow, promote peripheral venous reflux, and improve lower extremity edema. Injections of nerve-destroying drugs can treat malignant or cancerous sympathetic neuralgia. Complications and their prevention Accidental puncture into the subarachnoid space and epidural, causing extensive blockage after drug injection and resulting in respiratory and circulatory disorders. Repeated punctures can damage nerves and cause neuralgia; there is also a chance of damaging large blood vessels or puncturing lumbar intervertebral discs, so extra care should be taken during surgery. Although the injected medication is effective, attention should be paid to the possible drop in blood pressure.