When is sympathetic blockade indicated in pain management?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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Sympathetic blockade is often useful for other pain disorders, including postamputation pain syndromes and peripheral vascular disease, such as acute or chronic occlusive arterial disease and vasospastic disorders. Blockade of sympathetic nerves to the thoracic or abdominal viscera often alleviates severe visceral pain that is not amenable to other therapies. Thoracic visceral pain, such as that of acute myocardial infarction and angina pectoris, may activate reflex coronary vasoconstriction by segmentally induced sympathetic stimulation, which conversely further aggravates cardiac ischemia.

In these cases, cervicothoracic sympathetic blockade and, if necessary, neurolytic sympathectomy may be considered useful as adjunctive treatments. Celiac plexus block or continuous segmental T5-T10 block can be used to interrupt nociceptive afferents associated with pancreatitis, biliary and ureteral colic, and adynamic ileus, as well as painful visceral conditions caused by malignancy. Sympathetic blockade at the appropriate segmental level also has been prescribed in cases of acute herpes zoster and postherpetic neuralgia.

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