title: [Neurolitic block of the lumbar sympathetic chain improves chronic pain in a patient with critical lower limb ischemia].
abstract: OBJECTIVE
  Sympathectomy is one of the therapies used in the treatment of chronic obstructive arterial disease (COAD). Although not considered as first-line strategy, it should be considered in the management of pain difficult to control. This clinical case describes the evolution of a patient with inoperable COAD who responded properly to the lumbar sympathetic block.
  
  
  METHODS
  A female patient, afro-descendant, 69 years old, ASA II, admitted to the algology service due to refractory ischemic pain in the lower limbs. The patient had undergone several surgical procedures and conservative treatments without success. Vascular surgery considered the case as out of therapeutic possibility, unless limb amputation. At that time, sympathectomy was indicated. After admission to the operating room, the patient was monitored, positioned and sedated. The blockade was performed with the aid of radioscopy, bilaterally, at L2-L3-L4 right and L3 left levels. On the right side, at each level cited, 3mL of absolute alcohol with 0.25% bupivacaine were injected without vasoconstrictor, and on the left side only local anesthetic. The procedure was performed uneventfully. The patient was discharged with complete remission of the pain.
  
  
  CONCLUSIONS
  Neurolitic block of the lumbar sympathetic chain is an effective and safe treatment option for pain control in patients with critical limb ischemia patients in whom the only possible intervention would be limb amputation.
authors.affiliation: CET Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil. Electronic address: elton.sa.junior@gmail.com.
authors.forename: Elton Pereira de Sá
authors.initials: EPS
authors.lastname: Barreto Junior
authors.affiliation: CET Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil.
authors.forename: Jedson Dos Santos
authors.initials: JDS
authors.lastname: Nascimento
authors.affiliation: CET Santa Casa de Misericórdia da Bahia, Salvador, BA, Brasil.
authors.forename: Anita Perpetua Carvalho Rocha
authors.initials: APCR
authors.lastname: de Castro
mesh_terms: D000368:Aged; D001340:Autonomic Nerve Block / Q000379:methods*; D059350:Chronic Pain / Q000209:etiology / Q000601:surgery*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007511:Ischemia / Q000150:complications; D035002:Lower Extremity / Q000098:blood supply; D008160:Lumbosacral Plexus; D059408:Pain Management / Q000379:methods*
keywords: Dor intratável; Intractable pain; Ischemia; Isquemia; Tratamento; Treatment
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