Complete Pain Relief after Combining Radiofrequency and Phenol for Lumbar Sympathectomy

Abstract

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.

Study of Chemical Neurolysis, Radiofrequency Ablation and Combined Radiofrequency with Chemical Neurolysis of Lumbar Sympathetic Ganglion in Peripheral Vascular Diseases of the Lower Limbs

“…However, accuracy of targeted structure is extremely difficult, and range of ablation is limited [12,19]. Manjunath et al [13] conducted a pilot study on 20 patients of CRPS type-I to compare the chemical neurolysis with 7% phenol and RF lumbar sympathectomy.…”

“…Fifty such patients were studied by Usmani et al [21] with chemical lumbar sympathectomy(n=25) and found significant reduction in development of phantom limb pain, VAS score, quality of life compared to control group (n=25) [21] Recently combined chemical neurolysis and radiofrequency ablation of lumbar sympathetic ganglion is also studied in PVDs with diabetic techniques but there are limited studies to establish significant advantage of prolonged effects with RF over chemical neurolysis [10,13]. Hence combined methods are studied as by Dhafir A et al [12] who used pulsed RF with phenol at three levels (L2,3,4) for lumbar sympathectomy in a case of CRPS and found satisfactory result [10]. Yuanyuan Ding et al [7] Warmth improves the cutaneous circulation in ischemic limbs [27] Angiography has been used but difficult to predict the response.…”

“…There are studies regarding use of RF for sympatholysis, its comparison with chemical neurolysis with superior results with lesser complications. [9][10][11][12][13] Based on these studies we hypothesized that RF is a better alternative and aimed to study the efficacy of RF and of combined techniques i.e. RF with chemical LSGB using 8% phenol.…”