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腰交感神经节阻滞在下肢疼痛中的疗效及其围手术期应用前景

Efficacy of the lumbar sympathetic ganglion block in lower limb pain and its application prospects during the perioperative period.

作者信息

Zhang Jing-Han, Deng Yan-Ping, Geng Min-Jian

机构信息

Department of Anesthesiology, Class 2020 Group Southwest Medical University Luzhou China.

Department of Anesthesiology Southwest Meducal University Luzhou China.

出版信息

Ibrain. 2022 Oct 9;8(4):442-452. doi: 10.1002/ibra.12069. eCollection 2022 Winter.

Abstract

The sympathetic nervous system is involved in the physiological pathogenesis of many different types of chronic pain. Sympathetic blocks can interrupt the reflex control system by intercepting the noxious afferent fibers accompanying autonomic nerves, resulting in changes in peripheral or central sensory processing. A lumbar sympathetic ganglion block (LSGB), as a treatment method, refers to the injection of nerve blockers into the corresponding lumbar sympathetic nerve segments, usually requiring imaging assistance (CT, X-ray, ultrasound) to guide. At present, LSGB has been widely used in the clinical treatment of lower limb pain, such as neuropathic pain, lower limb ischemic pain, and so on. Its mechanism of action may be through inhibiting sympathetic nerve activity and dilating blood vessels, thereby alleviating pain and inhibiting stress response. However, there are few reports of LSGB during the perioperative period, especially in postoperative pain and gastrointestinal function. Therefore, by studying the literature about LSGB-related studies, this article reviews the anatomy of the lumbar sympathetic nerve (LSN), with its clinical application and possible mechanism. We reviewed the analgesic effect of LSGB in patients with lower limb pain and postoperative pain and the potential application prospects in the recovery of gastrointestinal function, finally providing a reference for its clinical application.

摘要

交感神经系统参与多种不同类型慢性疼痛的生理发病机制。交感神经阻滞可通过阻断伴随自主神经的有害传入纤维来中断反射控制系统,从而导致外周或中枢感觉处理的改变。腰椎交感神经节阻滞(LSGB)作为一种治疗方法,是指向相应的腰交感神经节段注射神经阻滞剂,通常需要影像学辅助(CT、X线、超声)引导。目前,LSGB已广泛应用于下肢疼痛的临床治疗,如神经病理性疼痛、下肢缺血性疼痛等。其作用机制可能是通过抑制交感神经活动和扩张血管,从而减轻疼痛并抑制应激反应。然而,关于LSGB在围手术期的报道较少,尤其是在术后疼痛和胃肠功能方面。因此,通过研究与LSGB相关的文献,本文综述了腰交感神经(LSN)的解剖结构、其临床应用及可能的机制。我们回顾了LSGB对下肢疼痛和术后疼痛患者的镇痛效果以及在胃肠功能恢复方面的潜在应用前景,最终为其临床应用提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eedb/10529158/70fb3a7cfb5f/IBRA-8-442-g003.jpg

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