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Incidence of inadvertent intercostal or epidural spread during thoracic sympathetic ganglion block

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Author(s)
홍지희김지섭
Alternative Author(s)
Hong, Ji HeeKim, Ji Seob
Publication Year
2020
Keyword
Anatomical differenceInadvertent injectionInjectionepiduralintercostalSkin temperatureSympathetic blocksSympathetically maintained painThoracic sympathetic ganglion
Abstract
Background:
Sympathetic blocks (SBs) have been used widely to relieve the symptoms of sympathetically maintained pain (SMP). The thoracic sympathetic ganglion is not separated from somatic nerves by muscles and connective tissue. The upper thoracic ganglion runs along the posterior surface of the vertebral column in close proximity to the adjacent epidural region. This anatomical difference leads to frequent epidural and intercostal spread in cases of thoracic SBs. The purpose of this study was to investigate the incidence of inadvertent intercostal and epidural injections during thoracic SBs.

Methods:
Twenty-two patients who were suffering from complex regional pain syndrome or lymphedema after breast cancer surgery were managed with two or three times of thoracic SBs. Therefore, injections of 63 thoracic SBs from 22 patients were enrolled in this study. An investigator who did not attend the procedure evaluated the occurrence of intercostal or epidural spread using anteroposterior fluoroscopic images.

Results:
The overall incidence of inadvertent intercostal or epidural spread of contrast was 47.5%. Among the inadvertent injections, intercostal spread (34.9%) was more frequent than epidural spread (12.6%). Only 52.5% of the thoracic SBs demonstrated successful contrast spread without any inadvertent spread. The mean difference in skin temperature between the blocked and unblocked sides was 2.5 ± 1.8ºC. Fifty-nine (93.6%) injections demonstrated more than 1.5ºC difference.

Conclusions:
Thoracic SBs showed a high incidence (47.5%) of inadvertent epidural or intercostal injection. Thus, special attention is required for the diagnosis of SMP or the injection of any neurolytic agent around sympathetic ganglion.
Department
Dept. of Anesthesiology & Pain Medicine (마취통증의학)
Publisher
School of Medicine (의과대학)
Citation
Ji Hee Hong. (2020). Incidence of inadvertent intercostal or epidural spread during thoracic sympathetic ganglion block. Anesthesia and Pain Medicine, 15(4), 486-491. doi: 10.17085/apm.20052
Type
Article
ISSN
2383--7977
DOI
10.17085/apm.20052
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/42918
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