Lumbar sympathetic blocks

[schmee90]

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Relatively new Attending, haven’t actually done a a lumbar sympathetic block or hypogastric blocks.

I looked up a bunch of sources on how to actually do the blocks and they actually look fairly technically straightforward in terms of obliquing until the transverse processes lines up with the VB touching os and then walking off from a lateral position until the needle is dorsal a few mm to the anterior edge of the vert body to stay away from great vessels. Go back to back AP and making sure you’re in mid pedicular period inject contrast make sure you’re not in muscle or vasculature

Hypogastric block I know you’re dealing with iliac crest which makes life a little harder but other then that any pearls from more seasoned docs? Thanks in advance.

 

[willabeast]

I like a stick on temperature probe on both legs with a digital readout, usually can tell quickly if got the sympathetics. Combine a short acting with a long acting local anesthetic.

 

[Logano2230]

I would recommend bending the needle further back than you normally would, around 1cm from the tip. Keep in mind you are crawling around 3 dimensional cylindrical structure. Aligning TP within the vertebral body usually means you’re touching os at about 40% depth on vertebral body. One move lateral gets around the apex, then advance with bend pointed medially until depth is just short of anterior cortex.

Contrast should look bubbly like an interlam and be medial to lateral cortex on AP. If it’s a dark vertical stripe you’re probably in muscle and not medial enough. Can always reset with a more oblique approach if it’s not working.