Lumbar Sympathetic Ganglion Block

Lumbar Sympathetic Ganglion Block

PEP Topic 
Lymphedema
Description 

A lumbar sympathetic ganglion block is an injection of local anesthetic in or around the sympathetic ganglia and lumbar sympathetic ganglia. This intervention was evaluated for treatment of lower limb lymphedema.

Effectiveness Not Established

Research Evidence Summaries

Woo, J.H., Park, H.S., Kim, S.C., & Kim, Y.H. (2013). The effect of lumbar sympathetic ganglion block on gynecologic cancer–related lymphedema. Pain Physician, 16, 345–352.

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Study Purpose:

To study treatment effect of lumbar sympathetic ganglion block (LSGB) on patients with lymphedema secondary to gynecologic cancer treatment who did not respond to conservative treatment, defined as complex decongestive physiotherapy or manual lymphatic drainage, compression therapy, exercise, and skin care.

Intervention Characteristics/Basic Study Process:

Fluoroscopy-guided LSGB was performed on stage II lower limb lymphedema patients three times at two-week intervals. Thigh and calf measurements were measured upright at first visit and two weeks post-LSGB.

Sample Characteristics:

  • N = 18 
  • AGE RANGE = 32–79 years
  • MALES: 0%, FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: 12 participants with stage II lower leg lymphedema; four participants with endometrial cancer; two participants with ovarian cancer
  • OTHER KEY SAMPLE CHARACTERISTICS: All participants underwent radiotherapy, and 17 underwent bilateral pelvic lymph node dissections.

Setting:

  • SITE:  Single site 
  • SETTING TYPE:  Outpatient 
  • LOCATION: Gynecologic oncology pain clinic at an academic outpatient center

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Mutliple phases of care
  • APPLICATIONS: Elder care, palliative care

Study Design:

  • Prospective clinical study

Measurement Instruments/Methods:

  • Thigh and calf circumference
  • Pain and satisfaction

Results:

Thigh and calf circumference reductions were greatest after the third LSGB and totaled 4 cm in thigh and 2 cm in calf. Pain score was also reduced.

Conclusions:

This was a very small study measuring an intervention with radiation exposure, and procedure risks appeared to outweigh benefit. No long-term follow-up was noted. The study lacked researcher reliability and validity, with no noted description of thigh and calf measurement tools.

Limitations:

  • Small sample (< 30)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Risk of bias (no appropriate attentional control condition)
  • Risk of bias (sample characteristics)
  • Key sample group differences that could influence results
  • Measurement/methods not well described
  • Measurement validity/reliability questionable
  • Intervention expensive, impractical, or training needs

Nursing Implications:

Careful consideration of risk to benefit ratio for patients undergoing LSGB is recommended because this procedure should only be performed under the auspices of research. High-quality controlled research studies with long-term follow-up are needed.


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