Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.03.011
Brazilian Journal of Anesthesiology
Clinical Information

Neurolitic block of the lumbar sympathetic chain improves chronic pain in a patient with critical lower limb ischemia

Bloqueio neurolítico da cadeia simpática lombar melhora dor crônica em paciente portadora de isquemia crítica de membro inferior

Elton Pereira de Sá Barreto Junior; Jedson dos Santos Nascimento; Anita Perpetua Carvalho Rocha de Castro

http://dx.doi.org/10.1016/j.bjane.2015.03.011 Braz J Anesthesiol, vol.68, n1, p.100-103, 2018
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Abstract

Abstract Background and objectives Sympathectomy is one of the therapies used in the treatment of chronic obstructive arterial disease (COAD). Although not considered as first-line strategy, it should be considered in the management of pain difficult to control. This clinical case describes the evolution of a patient with inoperable COAD who responded properly to the lumbar sympathetic block. Case report A female patient, afro-descendant, 69 years old, ASA II, admitted to the algology service due to refractory ischemic pain in the lower limbs. The patient had undergone several surgical procedures and conservative treatments without success. Vascular surgery considered the case as out of therapeutic possibility, unless limb amputation. At that time, sympathectomy was indicated. After admission to the operating room, the patient was monitored, positioned and sedated. The blockade was performed with the aid of radioscopy, bilaterally, at L2-L3-L4 right and L3 left levels. On the right side, at each level cited, 3 mL of absolute alcohol with 0.25% bupivacaine were injected without vasoconstrictor, and on the left side only local anesthetic. The procedure was performed uneventfully. The patient was discharged with complete remission of the pain. Conclusion Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation.

Keywords

Intractable pain, Ischemia, Treatment

Resumo

Resumo Justificativa/objetivos A simpatectomia é uma das terapêuticas usadas no tratamento dadoença arterial obstrutiva crônica (DAOP). Embora não seja considerada como estratégia de primeira linha, deve ser lembrada no manejo dos quadros de dor de difícil controle. Este caso clínico descreve a evolução de uma paciente portadora de DAOP inoperável que respondeu adequadamente ao bloqueio simpático lombar. Relato de caso Paciente do sexo feminino, parda, 69 anos, estado físico II, acompanhada no serviço de algologia devido a dor isquêmica refratária em membros inferiores. A paciente já havia sido submetida a diversas abordagens cirúrgicas e tratamentos conservadores, sem sucesso. A cirurgia vascular considerou o caso como fora de possibilidade terapêutica, a não ser amputação do membro. Nesse momento, foi indicada simpatectomia. Após admissão no centro cirúrgico, a paciente foi monitorada, posicionada e sedada. O bloqueio foi feito com auxílio da radioscopia, bilateralmente, nos níveis L2-L3-L4 à direita e L3 à esquerda. Do lado direito, em cada nível citado, foram injetados 3 mL de álcool absoluto com bupivacaína 0,25% sem vasoconstritor e do lado esquerdo somente o anestésico local. O procedimento foi feito sem intercorrências. A paciente recebeu alta com completa remissão da dor. Conclusão O bloqueio neurolítico da cadeia simpática lombar é uma opção de tratamento eficaz e segura para controle da dor em pacientes portadores de isquemia crítica, nos quais a única intervenção possível seria a amputação do membro.

Palavras-chave

Dor intratável, Isquemia, Tratamento

References

Garcia LA. Epidemiology and pathophysiology of lower extremity peripheral arterial disease. J Endovasc Ther. 2006;13:II3-9.

Davies MG. Criticial limb ischemia: epidemiology. Methodist Debakey Cardiovasc J. 2012;8:10-4.

Setacci C, Donato G, Teraa M. Chapter IV: treatment of critical limb ischaemia. Eur J Vasc Endovasc Surg. 2011;42(Suppl 2):S43-59.

Hertzer NR, Beven EG, Young JR. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984;199:223-33.

Araujo JB, Araujo Filho JB, Ciorlin E. Células-tronco de medula óssea em isquemia crítica de membros. Rev Bras Hematol Hemoter. 2009;31(Suppl. 1):128-39.

Emmerich J. Current state and perspective on medical treatment of critical leg ischemia: gene and cell therapy. Int J Low Extrem Wounds. 2005;4:234-41.

Weitz JI, Byrne J, Clagett GP. Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review. Circulation. 1996;94:3026-49.

Lin KB, Kin DI. Clinical application of stem cells for therapeutic angiogenesis in patients with peripheral arterial disease. Int J Stem Cells. 2009;2:11-7.

Brevetti G, Perna S, Sabba C. Effect of propionyl-l-carnitine on quality of life in intermittent claudication. Am J Cardiol. 1997;79:777-80.

Scheffler P, de la Hamette D, Gross J. Intensive vascular training in stage IIb of peripheral arterial occlusive disease. The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training. Circulation. 1994;90:818-22.

Maxwell AJ, Anderson BE, Cooke JP. Nutritional therapy for peripheral arterial disease: a doubleblind, placebo-controlled, randomized trial of HeartBar. Vasc Med. 2000;5:11-9.

Due L. Le traitment de la tromboangeite obiliterant des membres inférieures par la resection sympathique lombaire. J Cris. 1932;37:161-231.

Yoshida WB, Lemonica L, Rollo HA. Bloqueio simpático com fenol nas oclusões arteriais crônicas de membros inferiores. Cir Vasc Angiol. 1994;10:20-4.

Holliday FA, Barendregt WB, Slappendel R. Lumbar sympathectomy in critical limb ischaemia: surgical, chemical or not at all?. Cardiovasc Surg. 1999;7:200-2.

Sanni A, Hamid A, Dunning J. Is sympathectomy of benefit in critical leg ischaemia not amenable to revascularisation?. Interact Cardiovasc Thorac Surg. 2005;4:478-83.

Nesargikar PN, Ajit MK, Eyers PS. Lumbar chemical sympathectomy in peripheral vascular disease: does it still have a role?. Int J Surg. 2009;7:145-9.

Bhattarai BK, Rahman TR, Biswas BK. Fluoroscopy guided chemical lumbar sympathectomy for lower limb ischaemic ulcers. J Nepal Med Assoc. 2006;45:295-9.

Huttner S, Huttner M, Neher M. CT-guided sympathicolysis in peripheral artery disease – indications, patient selection, and long-term results. Rofo. 2002;174:480-4.

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