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CLINICAL INVESTIGATION REPORT
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 90-94

Fluoroscopy-guided lumbar sympathetic block with bupivacaine and depot methyl prednisolone for pain relief in buerger's Disease—Our experience


1 Professor and Head, Department of Anesthesiology, Critical Care and Pain, RG Kar Medical College, Kolkata, West Bengal, India
2 Postgraduate Trainee, Department of Anesthesiology, Critical Care and Pain, RG Kar Medical College, Kolkata, West Bengal, India

Correspondence Address:
Dipasri Bhattacharya
Professor and Head, Department of Anesthesiology, Critical Care and Pain, RG Kar Medical College, B26/10 Abhyudoy Housing, EKTP, Kolkata-700107, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.5005/jp-journals-10046-0019

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Background: Buerger's disease (BD) is a common peripheral vascular disease resulting in severe rest pain, leg ulcer, and claudication pain leading to decreased quality of life and disability. Lumbar chemical sympathectomy is now being used to relieve pain in BD. Purpose of this study was to assess the effectiveness of lumbar sympathetic block (LSB) in relieving rest pain, ulcer healing, decreased swelling and improvement in claudication distance (CD) for a considerable period. Materials and methods: This was a prospective observational study on thirty-two consecutive patients, who attended our pain clinic. Each patient received LSB bilaterally under fluoroscopy at L3 level with bupivacaine (0.25%) 10 ml and depot methylprednisolone (20 mg) on each side. As per our departmental protocol, the procedure was repeated for three times at an interval of 6 weeks. We compared the pain by visual analog scale (VAS), CD, healing of leg ulcer, pedal swelling following each injection. Results: Visual analog scale and claudication distance were improved significantly after second and third compared to first intervention (p < 0.05) but no significant differences observed between second and third intervention. Healing of leg ulcers and decreased pedal swelling were observed after each block. Conclusion: Multiple doses of fluoroscopy guided LSB with bupivacaine and depot methyl prednisolone is safe and effective in relieving rest pain, improving CD, promoting ulcer healing in patients of BD when conservative therapies are ineffective but how many doses will be optimal is still a matter of debate.


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