PERCUTANEOUS LUMBAR SYMPATHETIC PLEXUS CATHETER PLACEMENT FOR SHORT-TERM AND LONG-TERM PAIN RELIEF - CT TECHNIQUE AND RESULTS

Purpose: The purpose of this work was to evaluate the use of percutane ously placed lumbar sympathetic plexus catheter placement under CT gui dance in patients with complex regional pain syndrome (CRPS) or nonspe cified neuropathic pain (NP) of the lower extremity. Method: Sixteen l umbar sympathetic plexus catheter placements were performed in seven p atients with CRPS and seven patients with NP. A 19 gauge epidural cath eter was placed anterior to the psoas muscle at the L2-3 level. Twenty -five to 840 mg of bupivacaine hydrochloride per day was administered for a 1 to 8 day duration. Results: In CRPS patients, there was comple te short-term pain relief in one patient, considerable in four, mild i n one, and none in one. There was total long-term pain relief in one p atient and considerable long-term pain relief in three. In three patie nts, there was enduring pain relief at last follow-up. In NP patients, the procedure yielded considerable short-term pain relief in four, mi ld in two, and none in one. There was no enduring long-term relief in any of these patients. A retroperitoneal abscess developed in one pati ent and resolved on intravenous antibiotics without sequelae. Conclusi on: Percutaneous lumbar sympathetic plexus catheter placement is easil y performed, achieves short-term pain relief in the majority of patien ts, and may prove effective in long-term pain relief of CRPS patients.