Assistant Professor Weill Cornell Medical College, United States
Learning Objectives:
Outline the indications and uses for sympathetic nerve blocks, neurolysis and/or ablation.
Illustrate different technical considerations and troubleshooting tips for image guided sympathetic nerve blocks using a case based approach from head to toe including stellate ganglion, splanchnic nerves, celiac plexus, lumbar sympathetic plexus, superior and inferior hypogastric plexuses, and impar ganglion.
Review existing evidence regarding the safety and efficacy of these nerve blocks.
Background: Sympathetic nerve blocks can be used by interventionalists to treat a variety of chronic pain issues, as well as, provide peri-procedural analgesia for procedures such as uterine artery embolization {1}. Indications for sympathetic nerve blocks may include but are not limited to cancer-related pain, complex regional pain syndrome (CRPS), chronic abdominal visceral pain, chronic pelvic pain disorders, and ischemic lower extremity pain {2}. We aim to provide the interventional radiologist with an overview of sympathetic nerve blocks including indications, technical and anatomic considerations, as well as, review existing data.
Clinical Findings/Procedure Details: The educational presentation will include indications, technical details, and possible adverse events for each type of sympathetic nerve block. Intra-procedural images will be shown to highlight the use of different imaging modalities and various approaches.
Stellate ganglion nerve block for post COVID symptoms: Intraprocedural ultrasound images will be shown, highlighting important structures of interest.
Celiac plexus and superior hypogastric plexus nerve block for cancer associated pain: Varied needle approaches for different patients will be demonstrated, highlighting the benefits of different approaches. We will also cover combined utilization of celiac plexus and superior hypogastric plexus neurolysis for cancer-related pain.
Inferior hypogastric plexus block for chronic pelvic/urethral pain: We will showcase a novel technical lateral approach for this procedure utilizing CT guidance.
Impar ganglion block for cancer related pain and/or chronic coccydynia: Example cases will show the multiple approaches to impar ganglion nerve blocks and neurolysis including a cryoablation case with carbo/hydro-dissection to avoid complications.
Conclusion and/or Teaching Points: Sympathetic nerve blocks can be a valuable toolkit for IRs interested in chronic pain management for patients with various pain syndromes. Proper understanding of the indications, techniques, and possible adverse events are critical for those performing these procedures.
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