Sympathetic Block

Blockade of the sympathetic nervous system can be more selectively accomplished than that which occurs during spinal or epidural anesthesia. Cell bodies for pre-ganglionic sympathetic nerves originate in the interme-diolateral cell column of the spinal cord, from the first thoracic to the second lumbar segments. The myelinated axons of these cells travel as white communicating rami before joining the sympathetic chain and synapsing in the ganglia. The best location for a sympathetic block is at the sympathetic ganglia, since a block at this level will affect only the sympathetic nerves. For example, local anesthetic blockade of the stellate ganglion (which includes T1) blocks sympathetic innervation to all of the upper extremity and head on the injected side. A block of the sympathetic chain at L2 affects all of the lower extremity. This form of local anesthesia is particularly useful during treatment of a variety of vasospastic diseases of the extremities and for some pain syndromes.

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