PERIPHERAL VASCULAR DISEASE
PVD is a multifactorial syndrome that progressively gives rise to ischemic pain of the affected limb.Claudication is a cramping pain that occurs when blood flow to a limb is inadequate to meet its metabolic demands. Severity of claudication is inversely proportional to muscle activity in the limb, which will be minimized by rest.
In the early stages of the arteriosclrotic disease. However, as the disease progresses, blood flow will become inadequate even for resting metabolic demands and rest pain will start.
- Common causes of PVD include arteriosclerosis in connection with Diabetes
- Raynaud's disease involving exaggerated vesoconstrictor reflex response during exposure to cold, most commonly in upper limbs
- Buerger's disease, also known as thromboangitis obliterans, caused by inflammation of small vessels in the legs and sometimes in the arms; and embolic occlusive disease
Less common causes of peripheral-vascular pain include popliteal artery entrapment, adventitial cyctic disease of popliteal artery and compartmental syndromes.
Lumber sympathetic or Stellate Ganglion Block is used for diagnostic and therapeutic purposes for patients with certain types of pain syndromes involving lower or upper extremity attributable to sympathetic hyperactivity.
LUMBER SYMPATHETIC BLOCK :
“Lumber sympathetic nerves” are placed on the front of lumber spines in a chain coming from the upper spines which carry special signals from lower extremity blood vessels.
Some specific conditions, certain injuries in lower limb like, operation, fracture, trauma, a burning pain or increased pain sensation, swelling, decreased movements occur which is called Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome.
Injecting a small amount of Local Anesthetic on the lumber sympathetic nerves can identify whether this pain is carried by lumber sympathetic nervous system.
It is typically done lying on your stomach under local anesthesia and under radiological guidance. Shortly after the injection you may feel your pain is diminishing and your leg becoming warm which is expected.
Overall, this procedure has very less risk. However, as with any spine procedure, there are some risks and side effects you should know about. Commonly encountered side effects are transient increase in pain (usually temporary), rarely inadvertent puncture of the “sack” containing spinal fluid, puncture of blood vessels around the spine, bleeding, nerve injury or no relief of your pain.
If you are allergic to any of the medicine to be injected, it is better to avoid the procedure. If you are taking blood thinning drugs like Aspirin, Clopidogrel, Warferin etc, it is advisable to stop those medicines for 5-7 days before injection.
STELLATE GANGLION BLOCK (CERVICO-THORACIC SYMPATHETIC BLOCK):
The stellate ganglion refers to the ganglion or nerve bundle formed by the fusion of the inferior cervical nerves and the first thoracic ganglion as they meet anterior to the vertebral body of C7. ,br>
Some specific conditions, certain injuries in upper limb like, operation, fracture, trauma, a burning pain or increased pain sensation, swelling, decreased movements occur which is called Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome.
Injection is given in the lower part of the neck on the C6 / C7 vertebra under radiological guidance under local anesthesia.
Injecting a small amount of Local Anesthetic on the stellate ganglion nerves can identify whether this pain is carried by Cervico-thoracic sympathetic nervous system.
Other indications of stellate ganglion block are phantom limb pain, Harpes zoster, frostbite, shoulder / hand syndrome etc.
It shouldn’t be given in recent myocardial infarction patient, Glaucoma, coagulation disorder.
Though complications are rare but has to be done carefully to avoid nerve and vessel injury, lung injury, esophageal injury, infection etc.
The onset of Horner's syndrome indicates a successful block which is characterized by dropping of eyelid, pinpoint pupil, facial flushing etc.