| 18F-057 |
Combined radiofrequency and chemical neurolysis of lumbar sympathetic ganglion on gynecologic cancer-related lymphedema
Department of Anesthesiology and Pain Medicine, St. Vincent\'s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Introduction
Gynecologic cancer-related lymphedema is a common problem, characterized by a chronic, swollen leg. Lymphedema causes chronic pain, heaviness and a decreased quality of life. The standard treatment of lower limb lymphedema (LLL) is a conservative treatment. There are a few studies that lumbar sympathetic ganglion block (LSGB) can be helpful on gynecologic cancer-related lymphedema. However, there is no report on the effect of neurolysis of lumbar sympathetic ganglion (LSG) in gynecologic cancer-related lymphedema. We hereby report the case of a patient treated with combined radiofrequency and chemical neurolysis of LSG for cervical cancer-related lymphedema.
Case
A 46-year-old woman was referred to our pain clinic with LLL. She was diagnosed with cervical cancer with bone metastasis in the left iliac bone. The patient had pain, heaviness and a limited range of motion in the left leg. The patient underwent caudal block, transforaminal block and continuous epidural block. However, the effects were not satisfactory. We performed LSGB on the patient 2 times at 1-week interval. The pain decreased from NRS 7 to 3. The circumference of the patient’s thigh and calf decreased by 4cm and 2cm, respectively. We decided to perform combined radiofrequency and chemical neurolysis for the longer effect. The procedure was performed on the affected side at the L2, L3 and L4 levels. The 15cm radiofrequency electrode was introduced at an angle via tunnel vision technique under fluoroscopic guidance. After checking the correct needle position by contrast medium, the sensory and motor tests were done with 50Hz, 1.0 V electrical stimulation and 2 Hz, 1.0 V electrical stimulation. There was no muscle twitch and somatic nerve stimulation. 1ml of 2% lidocaine was injected. 5 minutes later radiofrequency thermocoagulation was conducted. The temperature was set at 70, 75 and 80℃ and three cycles were done for each temperature, with 100 seconds for each cycle. Subsequently, 2ml of dehydrated alcohol was injected to each level. The pain score by the NRS was 2. The tightness and heaviness of the affected limb was alleviated. The relief of symptoms was observed to have well maintained after one month.
Conclusion
We suggest that combined radiofrequency and chemical neurolysis of LSG can be a therapeutic option for the treatment of gynecologic cancer-related lymphedema.
Gynecologic cancer-related lymphedema is a common problem, characterized by a chronic, swollen leg. Lymphedema causes chronic pain, heaviness and a decreased quality of life. The standard treatment of lower limb lymphedema (LLL) is a conservative treatment. There are a few studies that lumbar sympathetic ganglion block (LSGB) can be helpful on gynecologic cancer-related lymphedema. However, there is no report on the effect of neurolysis of lumbar sympathetic ganglion (LSG) in gynecologic cancer-related lymphedema. We hereby report the case of a patient treated with combined radiofrequency and chemical neurolysis of LSG for cervical cancer-related lymphedema.
Case
A 46-year-old woman was referred to our pain clinic with LLL. She was diagnosed with cervical cancer with bone metastasis in the left iliac bone. The patient had pain, heaviness and a limited range of motion in the left leg. The patient underwent caudal block, transforaminal block and continuous epidural block. However, the effects were not satisfactory. We performed LSGB on the patient 2 times at 1-week interval. The pain decreased from NRS 7 to 3. The circumference of the patient’s thigh and calf decreased by 4cm and 2cm, respectively. We decided to perform combined radiofrequency and chemical neurolysis for the longer effect. The procedure was performed on the affected side at the L2, L3 and L4 levels. The 15cm radiofrequency electrode was introduced at an angle via tunnel vision technique under fluoroscopic guidance. After checking the correct needle position by contrast medium, the sensory and motor tests were done with 50Hz, 1.0 V electrical stimulation and 2 Hz, 1.0 V electrical stimulation. There was no muscle twitch and somatic nerve stimulation. 1ml of 2% lidocaine was injected. 5 minutes later radiofrequency thermocoagulation was conducted. The temperature was set at 70, 75 and 80℃ and three cycles were done for each temperature, with 100 seconds for each cycle. Subsequently, 2ml of dehydrated alcohol was injected to each level. The pain score by the NRS was 2. The tightness and heaviness of the affected limb was alleviated. The relief of symptoms was observed to have well maintained after one month.
Conclusion
We suggest that combined radiofrequency and chemical neurolysis of LSG can be a therapeutic option for the treatment of gynecologic cancer-related lymphedema.
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