Presented at the 2013 AAPM Annual Meeting « Back

Successful Treatment of Lower Extremity Lymphedema with Lumbar Sympathetic Blocks

Michael Danko, MD, dankoml@ucmail.uc.edu¹, Harsh Sachdeva, MD², Kevin Kohan, DO³, (1) University of Cincinnati, Cincinnati, Ohio, (2) University of Cincinnati College of Medicine, Cincinnati, Ohio, (3) University Of Cincinnati, West Chester, Ohio

Introduction: Lymphedema results from impaired lymphatic drainage causing interstitial accumulation of protein-rich fluid and subsequent inflammation, adipose tissue hypertrophy, and fibrosis(1). We present the case of a person with chronic leg pain due to lymphedema treated successfully with lumbar sympathetic blockade. Methods: A 56 year old female presented with chronic pain from lymphedema of the right leg following a vein harvest from that leg as part of a labial cancer resection and reconstruction. Her pain was poorly controlled with previous conservative interventions prior to her referral. Two lumbar sympathetic blocks were performed three weeks apart from each other with identical methodology. The patient was placed in the prone position. Utilizing fluoroscopy, a 22G 5” spinal needle was advanced lateral to the transverse process of L3 on the right until the needle tip was positioned on the anterior border of the L3 vertebral body. Contrast was injected to identify the lumbar sympathetic chain followed by an injection of 15 ml of 0.375% bupivacaine with 1:200,000 epinephrine and 80 mg of methylprednisolone. Results: At her one month follow up, the patient reported 75% improvement in leg pain and greater than 50% reduction in the circumference of her right thigh and leg. The patient also noted improved ambulation and greater participation in physical therapy. Conclusions: Lumbar sympathetic blocks appear to be an effective treatment for leg pain caused lymphedema. Lumbar sympathectomy may enhance lymphatic drainage resulting in decreased fluid retention and tissue swelling leading to decreased pain. References: 1) Warren AG, et al. Lymphedema: A Comprehensive Review. Ann Plast Surg 2007; 59: 464-472. 2) Asai Y, et al. Effects of lumbar sympathetic ganglion block in a patient with acquired lymphangioma. Masui. 2001 Oct; 50(10): 1121-2.

Funding: None