Change in Skin Temperatures in Lumbar Sympathetic Ganglion Block Showing Three Different Contrast Spread Patterns

Abstract

We hypothesized that if a fluoroscopic image of the lumbar sympathetic ganglion block (LSGB) showed the spread patterns of contrast at both the L2/3 and L4/5 disc areas, then this would demonstrate a more profound blockade effect because the spread patterns are close to sympathetic ganglia. Forty five patients were classified into three groups(Group A : contrast spreads at the ventral side of both L2-L3 and L4-L5 disc areas, Group B : contrast spreads at one disc level of L2-L3 or L4-L5, Group C : no contrast spreads around either L2-L3 or L4-L5 disc areas) according to their contrast spread pattern. Preblock and maximum postblock temperature (Tpre, Tpost, ℃), the preblock temperature difference between the ipsilateral and contralateral great toe (DTpre, ℃), and the postblock temperature difference between the ipsilateral and contralateral great toe (DTpost, ℃) were measured and calculated. DTnet was calculated as follows. DTnet = DTpost -DTpre. Group A showed the most significant changes in DTpost (7.5 ± 1.2℃, p = 0.015), and DTnet (6.9 ± 1.0℃, p = 0.017) compared to group C. Other parameters including T1℃, Tpre, Tpost, and DTpre were similar between groups. Group A showed significant sympatholytic effect compared to group C. To obtain a more complete sympathetic block, assessing the contrast spread pattern after the LSGB is an important step as well as measuring skin temperature.