Pain physician
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Case Reports
Successful treatment of post thrombotic syndrome with sequential lumbar sympathetic block.
An underappreciated sequelae of deep venous thrombosis (DVT) is the pain associated with the blood clot in the peripheral extremity. Although most frequently acute in nature, DVT occasionally presents with chronic pain in the affected limb. Furthermore, many individuals suffering from prothrombotic states often have recurring pain from DVT. ⋯ Compression boot/stocking therapy was not combating the discomfort associated with the PTS, often increasing the severity of the patient's pain. Sequential right lumbar sympathetic blocks were performed, which nearly completely resolved the patient's symptoms and improved the patient's ambulatory status and ability to perform activities of daily living. Sympathetic nerve blocks should be considered as a treatment option for patients who suffer with pain from PTS.
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The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the ganglion impar neurolysis have been described in the literature. ⋯ A combined neurolytic SHGP block with GI block is an effective and safe technique for reducing pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach.