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Ureteral Injury After Lumbar Sympathetic Block

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Abstract

Ureteral injury caused by lumbar sympathetic block is a rare but potentially serious complication. To date, seven cases have been reported in the literature [1,2,3,4,5]. The postulated etiology includes chemical irritation of the ureter and subsequent stenosis caused either by direct injection into the ureter or by spread of the agent from the injection site. Patients may present with symptoms ranging from systemic constitutional symptoms to more localized manifestations; timing of presentation may occur as early as 4 days and as late as 6 months post-procedure. Diagnosis is made by imaging, often initially including an ultrasound demonstrating a urinoma and/or hydronephrosis of the ipsilateral kidney. Management is patient-dependent and has ranged from conservative management with drainage to ureteral repair and nephrectomy.

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References

  1. Fraser I, Windle R, Smart JG, Barrie WW. Ureteric injury following chemical sympathectomy. Br J Surg. 1984;5:349.

    Article  Google Scholar 

  2. Trigaux J-P, Decoene B, Beers BV. Focal necrosis of the ureter following CT-guided chemical sympathectomy. Cardiovasc Intervent Radiol. 1992;15:180–2.

    Article  CAS  PubMed  Google Scholar 

  3. Cutts S, Williams H, Lee J, Downing R. Lesson of the Month: ureteric injury as a complication of chemical sympathectomy. Eur J Vasc Endovasc Surg. 2000;2:212–3.

    Article  Google Scholar 

  4. Dirim A, Kumsar S. Iatrogenic ureteral injury due to lumbar sympathetic block. Scand J Urol Nephrol. 2008;42(4):492–3.

    Article  PubMed  Google Scholar 

  5. Ranjan P, Kumar J, Chipde S. Acute renal failure due to bilateral ureteric necrosis following percutaneous chemical lumbar sympathectomy. Indian J Nephrol. 2012;22(4):292–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Middleton WJ, Chan VW. Lumbar sympathetic block: a review of complications. Tech Reg Anesth Pain Manag. 2008;2(3):137–46.

    Article  Google Scholar 

  7. Abramov R. Lumbar sympathetic treatment in the management of lower limb pain. Curr Pain Headache Rep. 2014;18(4):1–5.

    Article  Google Scholar 

  8. Yi X, Aubuchon J, Zeltwanger S, Kirby JP. Necrotic arachnidism and intractable pain from recluse spider bites treated with lumbar sympathetic block. Clin J Pain. 2011;27(5):457–60.

    Article  PubMed  Google Scholar 

  9. Cheng J, Daftari A, Zhou L. Sympathetic blocks provided sustained pain relief in a patient with refractory painful diabetic neuropathy. Case Rep Anesthesiol. 2012;1–5.

    Google Scholar 

  10. Gebauer A. Chronic exercise-induced leg pain in an athlete successfully treated with sympathetic block. Am J Sports Med. 2005;33(10):1575–8.

    Article  PubMed  Google Scholar 

  11. Wallace G. A lateral approach for lumbar sympathetic nerve block. Anesthesiology. 1955;16(2):254–60.

    Article  CAS  PubMed  Google Scholar 

  12. Ohno K, Oshita S. Transdiscal lumbar sympathetic block. Anesth Analg. 1997;85(6):1312–6.

    Article  CAS  PubMed  Google Scholar 

  13. Hong JH, Oh MJ. Comparison of multilevel with single level injection during lumbar sympathetic ganglion block: efficacy of sympatholysis and incidence of psoas muscle injection. Korean J Pain. 2010;23(2):131–6.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kirvela O, Svedstrom E, Lundbom N. Ultrasonic guidance of lumbar sympathetic and celiac plexus block: a new technique. Reg Anesth. 1992;17(1):43–6.

    CAS  PubMed  Google Scholar 

  15. König CW, Schott UG, Pereira PL, Trübenbach J, Schneider W, Claussen CD, Duda SH. MR-guided lumbar sympathicolysis. Eur Radiol. 2002;12(6):1388–93.

    Article  PubMed  Google Scholar 

  16. Tay VK, Fitridge R, Tie ML. Computed tomography fluoroscopy-guided chemical lumbar sympathectomy: simple, safe and effective. Australas Radiol. 2002;46(2):163–6.

    Article  PubMed  Google Scholar 

  17. Koizuka S, Saito S, Obata H, Tobe M, Koyama Y, Takahashi A. Anatomic analysis of computed tomography images obtained during fluoroscopic computed tomography-guided percutaneous lumbar sympathectomy. J Anesth. 2008;22(4):373–7.

    Article  PubMed  Google Scholar 

  18. van Eijs F, Stanton-Hicks M, Van Zundert J, Faber C, Lubenow T, Mekhail N, van Kleef M, Hoygen F. Complex regional pain syndrome. Pain Pract. 2011;11(1):70–87.

    Article  PubMed  Google Scholar 

  19. Cameron HU, Park YS, Krestow M. Reflex sympathetic dystrophy following total knee replacement. Contemp Orthop. 1994;29(4):279–81.

    CAS  PubMed  Google Scholar 

  20. Choi E, Choo C, Kim H, Lee P, Nahm F. Lumbar sympathetic block with botulinum toxin type B for complex regional pain syndrome: a case study. Pain Physician. 2015;18(5):E911–6.

    PubMed  Google Scholar 

  21. Chen L, Wong C, Huh B, Huang Y, Yang C, Yeh C, Wu C. Repeated lumbar sympathetic blockade with lidocaine and clonidine attenuates pain in complex regional pain syndrome type 1 patients—a report of two cases. Acta Anaesthesiol Taiwanica. 2006;44:113–7.

    Google Scholar 

  22. Haynsworth RF, Noe CE. Percutaneous lumbar sympathectomy: a comparison of radiofrequency denervation versus phenol neurolysis. Anesthesiology. 1994;74(3):455–63.

    Article  Google Scholar 

  23. Jackson TP, Gaeta R. Neurolytic blocks revisited. Curr Pain Headache Rep. 2008;12(1):7–13.

    Article  PubMed  Google Scholar 

  24. Heindel W, Ernst S, Manshausen G. CT-guided lumbar sympathectomy: results and analysis of factors influencing the outcome. Cardiovasc Intervent Radiol. 1998;21(4):319–23.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Sophy Zheng M.D. .

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Levin, D., Zheng, S., Anitescu, M. (2018). Ureteral Injury After Lumbar Sympathetic Block. In: Anitescu, M., Benzon, H., Wallace, M. (eds) Challenging Cases and Complication Management in Pain Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-60072-7_24

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  • DOI: https://doi.org/10.1007/978-3-319-60072-7_24

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-60070-3

  • Online ISBN: 978-3-319-60072-7

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