Korean J Pain.  2010 Mar;23(1):11-17.

Determination of Adequate Entry Angle of Lumbar Sympathetic Ganglion Block in Korean

• Kim WH
• Kim SK
• Lee CJ
• Kim TH
• Sim WS

Abstract

BACKGROUND
The target of lumbar sympathetic ganglion block is the anterolateral surface of the L2, 3 and 4 vertebral bodies, where the lumbar sympathetic ganglion usually lies. In most cases, a block-needle is inserted approximately 5-8 cm lateral to spinous process on the skin and directed to the anterolateral surface of vertebral body obliquely. The purpose of this study is to determine the safe entry angle and entry point in Korean by using the abdominal CT scan images.
METHODS
The abdominal CT images of eighty five patients were recruited to this study. The minimal angle aimed at the lumbar sympathetic ganglion that can pass through the lateral aspect of body and maximal angle that avoids puncturing the kidney, ureter or retroperitoneal space were measured. The distance from midline to skin entry point was also measured.
RESULTS
There was no significant difference in entry angle among L2, 3, and 4 level. The entry angle was similar in the right and left side, and in males and females. The entry angle of old age group was significantly smaller than that of young age group. The calculated safe entry angle was 30.5 +/- 0.4degrees and entry point was 7.7 +/- 0.2 cm and 6.7 +/- 0.1 cm lateral from midline in males and females respectively.
CONCLUSION
These measurements can be used as a reference for lumbar sympathetic ganglion block and radiofrequency lesioning. Prior to performing the lumbar sympathetic ganglion block for cancer patients, the abdominal CT scan should be reviewed to prevent complications.

Keyword

entry angle; entry point; lumbar sympathetic ganglion block; safety

MeSH Terms

Female
Ganglia, Sympathetic
Humans
Kidney
Male
Retroperitoneal Space
Skin
Ureter

Figure

• 

  Fig. 1 The imaginary target point (D) of a lumbar sympathetic ganglion block is at the anterolateral surface of the L2, 3, and 4 vertebral bodies. That is the point at the anterolateral surface met by the bisecting line (B) of two lines (A and C) bordering the pedicle.

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  Fig. 2 This figure shows the measurements in this study. The point (A) is the imaginary target of the lumbar sympathetic ganglion block. The angle (B) and (C) represent the minimal and maximal entry angle respectively. (D) and (E) represent the minimal and maximal skin entry distance from the midline respectively.

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  Fig. 3 The abdominal CT of a 38-year-old female patient with peritoneal seeding of stomach cancer shows that there is no safe skin entry angle that would not puncture the kidney for a lumbar sympathetic ganglion block.

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