1. 2013;16;345-352The Effect of Lumbar Sympathetic Ganglion Block on Gynecologic Cancer-Related Lymphedema
   Prospective Study
   Jae Hee Woo, MD, Hahck Soo Park, MD, PhD, Seung Cheol Kim, MD, PhD, and Yun Hwan Kim, MD, PhD.

BACKGROUND: Eighteen to 25% of patients after gynecological cancer treatment suffer from lower limb lymphedema (LLL) that decreases the quality of life of gynecological cancer survivors. Lumbar sympathetic ganglion block (LSGB) is widely used in practice for the evaluation and management of sympathetically mediated pain in the lower limbs. Several articles have suggested that sympathetic ganglion block could be an effective treatment for lymphedema.

OBJECTIVES: To investigate the effect of LSGB on patients with secondary lymphedema related to the treatment of gynecologic cancer, who do not respond to a conservative treatment.

STUDY DESIGN: Prospective clinical study.

SETTING: A single academic medical center, outpatient setting.

METHODS: Eighteen patients with stage II lower limb lymphedema who did not response to the conservative treatment were recruited. The patients underwent fluoroscopy-guided LSGB 3 times at 2-week intervals. The circumference of the thigh and calf was measured in the upright position at the first visit and 2 weeks after each session of LSGB. The pain score of the lower limb was checked at the same time by a numeric rating scale (NRS) from 0 to 10. The patients were asked about their satisfaction with the procedure at the last follow-up visit. The Wilcoxon signed rank test was used for data analysis. Significance was accepted at a P-value less than 0.05/3.

RESULTS: The circumferences of affected thighs and calves decreased from 56.38 ± 4.77 and 35.33 ± 3.51cm to 54.42 ± 5.27 and 34.41 ± 3.35cm, respectively, in a significant manner after 3 consecutive LSGBs (P < 0.05/3). The maximal decrease after the third LSGB was 4 cm in the thigh and 2cm in the calf. The pain score also showed a significant decrease after 3 consecutive LSGBs from 2.17 to 1.28. The tightness and heaviness of the affected limb decreased after the first LSGB in 15 patients (83.3%) and after the second LSGB in 2 patients (11.1%). Five of 18 patients (27.8%) answered that the result of the LSGB met their expectations, 10 (55.6%) answered they would undergo the same treatment for the same outcome, 2 (11.1%) answered they did not improve as much as they had hoped, and they would not undergo the same treatment for the same outcome, and only one patient (5.6%) answered the LSGB showed no effect.

LIMITATIONS: This study lacks a placebo control group and has only 18 patients. We did not evaluate the quality of life of the patients.

CONCLUSION: We suggest that LSGB can be one of the treatment options for patients suffering from LLL after gynecologic cancer treatment. Our result could provide a basis for a randomized controlled trial in future investigations. The pain physicians can play an important role as one of the multidisciplinary team for a comprehensive treatment of LLL.