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Review of Sympathetic Blocks: Anatomy, Sonoanatomy, Evidence, and Techniques

Baig, Samir MD*; Moon, Jee Youn MD, PhD; Shankar, Hariharan MBBS*‡

Regional Anesthesia and Pain Medicine: May/June 2017 - Volume 42 - Issue 3 - p 377–391
doi: 10.1097/AAP.0000000000000591
Chronic and Interventional Pain: Review Articles

The autonomic nervous system is composed of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is implicated in situations involving emergent action by the body and additionally plays a role in mediating pain states and pathologies in the body. Painful conditions thought to have a sympathetically mediated component may respond to blockade of the corresponding sympathetic fibers. The paravertebral sympathetic chain has been targeted for various painful conditions. Although initially injected using landmark-based techniques, fluoroscopy and more recently ultrasound imaging have allowed greater visualization and facilitated injections of these structures. In addition to treating painful conditions, sympathetic blockade has been used to improve perfusion, treat angina, and even suppress posttraumatic stress disorder symptoms. This review explores the anatomy, sonoanatomy, and evidence supporting these injections and focuses on ultrasound-guided/assisted technique for the performance of these blocks.

From the *Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI; †Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea; and ‡Clement Zablocki VA Medical Center, Milwaukee, WI.

Accepted for publication January 4, 2017.

Address correspondence to: Hariharan Shankar, MBBS, Department of Anesthesiology, Medical College of Wisconsin, 5000 W National Ave, Milwaukee, WI 53295 (e-mail:

Funding was provided by institutional resources only.

The authors declare no conflict of interest.

Copyright © 2017 by American Society of Regional Anesthesia and Pain Medicine.