Sympathetic Blocks

Interruption of the sympathetic chain is used as both a diagnostic and therapeutic intervention. Most commonly, in the pain management center, it is used to establish a diagnosis of sympathetically mediated pain in reflex sympathetic dystrophy. Therapeutic effects of the local anesthetic can be seen for a much longer duration than would be expected. The idea is that regional blockade somehow resets the sympathetic tone to a more normal state. Other conditions that sympathetic blockade is used includes peripheral vascular disease and Raynaud's disease, done to enhance regional blood flow, alleviate pain, and speed ulcer healing.

Sympathetic blockade is also used to treat pain from visceral origin. The classic indication for celiac plexus blockade is pancreatic cancer. This pain can be particularly difficult to treat with standard opiate regimens, and is probably one block done for cancer pain that is indicated earlier rather than later in the course of the disease. Superior hypogastric plexus blockade is used to treat pelvic pain, both from malignant and non-malignant causes. Finally, the terminal ganglion of the sympathetic chain, the Ganglion Impar, is easily accessible, and can be used to treat intractable rectal pain. The individual blocks are reviewed below.

• Celiac Plexus Block
  
  
• Ganglion Impar Blockade
  
  
• Lumbar Sympathetic Block
  
  
• Stellate Ganglion Blocks
  
  
• Superior Hypogastric Plexus Block
  
  

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