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Spinal anaesthesia (or spinal anesthesia), also called spinal block, subarachnoid block, intradural block and intrathecal block, [1] is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long.
This ganglion plays a crucial role in patients experiencing pain in the pelvic and perineal structures, as it provides both nociceptive and sympathetic supply to these regions. Afferent innervation to the ganglion impar comes from the perineum, distal rectum, anus, distal urethra, and distal vagina.
The upper two lumbar ganglia (L1 and L2) of the sympathetic chain also give rise to the lumbar splanchnic nerves. Splanchnic nerves are paired visceral nerves carrying preganglionic sympathetic and general visceral afferent fibers. The lumbar splanchnic nerves travel through the lumbar sympathetic ganglion but do not synapse there.
The needle-through-needle technique involves the introduction of a Tuohy needle (epidural needle) into the epidural space. The standard technique of loss of resistance to injection may be employed. A long fine spinal needle (25G) is then introduced via the lumen of the epidural needle and through the dura mater, into the subarachnoid space.
The technique usually involves exsanguination of the target region, which forces blood out of the extremity, followed by the application of pneumatic tourniquets to safely stop blood flow. The anesthetic agent is intravenously introduced into the limb and allowed to diffuse into the surrounding tissue while tourniquets retain the agent within ...
Lumbar sympathetic neurolysis is performed by using absolute alcohol, but other chemicals such as phenol, or other techniques such as radiofrequency or laser ablation have been studied. To aid in the procedure, fluoroscopy or CT guidance is used. Fluoroscopic guidance is the most frequent, giving better real-time monitoring of the needle.
The psoas lies posterolateral to the lumbar sympathetic ganglia, and the needle tip will often pass through the psoas major during a lumbar sympathetic block. The genitofemoral nerve is formed in the midsection of the psoas muscle by the union of branches from the anterior rami of L1 and L2 nerve roots. The nerve then courses inferiorly within ...
Lumbar sympathetic block: A procedure performed to manage pain originating from the lower back, buttocks or legs. [39] Common indications: complex regional pain syndrome (CRPS)/regional sympathetic dystrophy (RDS), post-herpetic neuralgia, neuropathy. Pudendal nerve block: A procedure performed to manage chronic pelvic pain.