Lumbar sympathectomy alleviates pain such as complex regional pain syndrome, phantom limb pain and other peripheral neuropathies. Different modalities have been used to manage complex syndromes including sympathectomy. Both radiofrequency (RF) and phenol injection are established methods of performing sympathectomy. We present a case with possible diagnosis of chronic regional pain syndrome in a 56 year old lady who presented as an emergency with severe unbearable pain in her right leg. As a result of compromised circulation in the legs, the distal phalanx of second toe was amputated. Diagnostic lumbar sympathectomy with local anaesthetics provided short and temporary pain relief. Lumbar sympathectomy by means of radiofrequency combined with phenol injection was used; the symptoms were alleviated within 12 hours. Follow-up at different intervals has shown remarkable subjective and objective recovery with improved circulation, discoloration and complete healing. To the best of our knowledge this is the first case report of sympathectomy combining the two modes of RF and phenol injection in the same session.

window was the SUBX, wherein calculation of the IVCCI and expeditious evaluation of cardiac function could be achieved. Declaration of interest None declared. 3. Nagdev AD, Merchant RC, Tirado-Gonzalez A, Sisson CA, Murphy MC. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure.