The Use of L2 and L3 Lumbar Sympathetic Blockade for Cancer-Related Pain, an Experience and Recommendation in the Oncologic Population

• Published in: Pain medicine (Malden, Mass.) Vol. 21; no. 1; pp. 176 - 184
• Main Authors: Spiegel, Matthew A, Hingula, Lee, Chen, Grant H, Legler, Aron, Puttanniah, Vinay, Gulati, Amitabh
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.01.2020
• Subjects: Analgesia; Anesthetics; Autonomic Nerve Block - methods; Cancer; Cancer pain; Cancer Pain & Palliative Care Section; Cancer Pain - therapy; Drug therapy; Female; Fluoroscopy; Humans; Injection; Leg; Lumbar Vertebrae; Male; Methods; Nerve block; Neuromodulation; Pain; Pain management; Pain Management - methods; Pain perception; Pelvis; Remission; Retrospective Studies; Sympathetic nervous system; Sympatholytic agents; United States; Lumbar Sympathetic Block; Cancer Pain
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnz142

Abstract Objective The sympathetic nervous system has a recognized role in transmission of pain, and the lumbar sympathetic blockade is intended to provide analgesia. We share our experiences of lumbar sympathetic blockade in the treatment of cancer-related pain. Methods We performed a retrospective analysis of patients with cancer-related pain in the back, abdomen, pelvis, or legs treated at Memorial Sloan Kettering Cancer Center between 2000 and 2018 undergoing lumbar sympathetic blockade at L2 or L3. Blocks were accomplished by injection of local anesthetic or local anesthetic with steroid under fluoroscopy. We measured numerical rating scale scores, percent relief, and relief time. The primary end point was defined as “effective” or “ineffective” pain relief. Effective pain relief was defined as ≥30% relief for at least one day. Results We identified 124 data points of lumbar sympathetic blockade at L2 or L3, of which 57 were with complete data and used for analysis. Peri-injection, 42 data points had active disease whereas 15 were in remission. Lumbar sympathetic blockade was 67% effective in the back pain cohort, 82% effective in the abdominopelvic pain cohort, and 75% effective in the leg pain cohort. Seventeen data points went on to neurolysis, two to neuromodulation, and eight to intrathecal pump implantation. Conclusions Lumbar sympathetic blockade is effective for back, abdominopelvic, and leg pain related to cancer and its treatments. Future research should be aimed at refining its role within multimodal pain management.