title: The use of lumbar sympathetic blockade at L4 for management of malignancy-related bladder spasms.
abstract: BACKGROUND
  Cancer-related bladder spasms may be a rare but severe symptom of bladder or metastatic cancer or its related treatments. Various treatments described in the literature include systemic medications, intravesical or epidural medications, or even sacral neurolectomies.
  
  
  OBJECTIVE
  We present 3 patients who have suffered from bladder spasm either from invasion of the bladder wall by tumor (2 patients) or from intravesical chemotherapeutic treatment.
  
  
  METHODS
  Case Report.
  
  
  METHODS
  Cancer pain management hospital.
  
  
  METHODS
  For each patient, we describe the use of lumbar sympathetic block to successfully treat the bladder spasms. Sympathetic blockade was performed at the left anterolateral border of lumbar vertebra L4. We used 10 mL of local anesthetic (0.25% bupivacaine) delivered in 2 mL aliquots, each given after negative aspiration for heme. Each procedure was performed with fluoroscopic guidance (both AP and lateral views) with the use of iodine contrast (Omnipaque-180) to confirm the location of the medication and its resulting spread.
  
  
  RESULTS
  All 3 patients had a reduction in the frequency and intensity of spasms, with 2 out of 3 patients not having a recurrence of the spasms for up to 2 months post procedure and follow up.
  
  
  CONCLUSIONS
  Case Report.
  
  
  CONCLUSIONS
  Lumbar sympathetic blockade could be a useful treatment for recurrent bladder spasm in the oncologic population. Based on these findings, we feel that the branches of the sympathetic nerve set at L4 may be a good target for neurolytic procedures, such as radiofrequency ablation, for long term treatment of bladder spasms. Further research is necessary to determine the efficacy of this technique for the treatment of bladder spasms in the oncologic population.
authors.affiliation: Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Gulati
authors.forename: Yury
authors.initials: Y
authors.lastname: Khelemsky
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Loh
authors.forename: Vinay
authors.initials: V
authors.lastname: Puttanniah
authors.forename: Vivek
authors.initials: V
authors.lastname: Malhotra
authors.forename: Kenneth
authors.initials: K
authors.lastname: Cubert
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000150:complications / Q000188:drug therapy / Q000556:secondary; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000150:complications / Q000188:drug therapy / Q000556:secondary; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000294:innervation*; D008297:Male; D010148:Intractable Pain / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D055502:Secondary Prevention; D013563:Sympathectomy, Chemical / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000556:secondary; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000209:etiology*