Lumbar Sympathetic Block

Lumbar sympathetic blockade is used predominantly for the diagnosis and treatment of lower extremity reflex sympathetic dystrophy. Relief of symptoms can far outlast the clinical duration of the local anesthetic. Repitition of the block, in conjunction with aggressive physical therapy, has classical been the management approach for RSD. The lumbar sympathetic ganlia lie anteriorly to the L2, L3, and L4 vertebral bodies. A single needle and two needle technique has been described, performed at the L2 and L3 level, usually under fluoroscopic guidance. Injection of radioopaque contrast confirms the proper position of the needles. The final position should be anterior to the psoas muscle fascia.

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