A Prospective Evaluation of Psoas Muscle and Intravascular Injection in Lumbar Sympathetic Ganglion Block
- Ji H. Hong; Ae R. Kim; Mi Y. Lee; Yong C. Kim; Min J. Oh
- Publication Year
- BACKGROUND: Intravascular and intramuscular injection of local anesthetics during lumbar
sympathetic ganglion block (LSGB) can cause false positive or negative results in a diagnostic
block, and complications. In the present study, we prospectively evaluated the incidence and
possible factors causing intravascular and IM injection during LSGB.
METHODS: We evaluated 216 LSGBs in 83 patients. All LSGBs were performed by 1 of the
authors using a 3-needle technique. After final needle position was confirmed by biplanar
fluoroscopy, an aspiration test was conducted, and 1 mL of contrast was injected sequentially.
Incidences of psoas muscle injection, blood flashback, and the presence of intravascular
contrast spread on static and real-time fluoroscopy were assessed.
RESULTS: The incidence of psoas muscle injection of contrast was 21.3% (46/216), and it was
associated with the level of injection (L2) significantly ( 2 14.773, P 0.001). The incidence
of intravascular injection of contrast was 12.5% (27/216). Among 27 cases of documented
intravascular injections, 5.1% (11/216) of patients showed contrast spread at the area where
the sympathetic ganglion was presumed to be and to the vessels simultaneously, and 7.4%
(16/216) of patients showed only intravascular injection of contrast. The sensitivity of the
aspiration test and static radiography were 40.7% and 70.4%, respectively.
CONCLUSIONS: LSGB at the L2 level showed the lowest incidence of psoas muscle injection of
contrast in comparison with LSGB at L3 and L4. The aspiration test and static radiography
frequently missed the intravascular injection of contrast during LSGBs. (Anesth Analg 2010;
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