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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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Chapter 41 – Lumbar Sympathetic Block


Lumbar sympathetic blocks are typically carried out to (1) improve blood flow to the lower extremities or (2) provide pain relief to the lower extremities.

Patient Selection.

Patients requiring lumbar sympathetic block can be divided into two primary groups: (1) those requiring sympathetic block because of ischemic vascular disease to the lower extremities (these patients are often older); and (2) patients requiring the block for diagnosis or treatment of complex regional pain syndromes of the lower extremities (these patients have a much wider age range).

Pharmacologic Choice.

Block of the sympathetic nervous system can be performed with lower concentrations of local anesthetics than almost any other regional block. For example, 0.5% lidocaine, 0.125% or 0.25% bupivacaine, and 0.1% or 0.2% ropivacaine are appropriate choices.

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