• - Significant peripheral artery disease
  - Lower limb complex regional pain syndrome with sympathetic component
  

Target: Anterolateral aspect of L2 and L4 vertebral bodies, between aorta (left) or inferior vena cava (right) and psoas muscle.

Procedure:

• - Patient in prone position
  - Axial scan from Th12 to L5 after i.v. contrast media injection
  - Delineation of the ureters and determination of the target slices
  - Posterolateral approach
  - Single sided puncture with CT fluoroscopy guidance at the L2 and L4 levels, from skin to target, with 15cm 22 gauge needles.
  - At each level, injection of 1mL of contrast media mixed with lignocaine (25/75%) to prove extravascular position of needle tip and evaluate diffusion.
  - Lumbar plexus neurolysis with an injection of 8mL of a 8% phenol in glycérine solution at each level.
  
• - Rinse needles with 1mL of lignocaine before withdrawal.
  

Danger:

• - Avoid ureteral puncture
  - Stop procedure if diffusion towards ureter or posterior third of vertebral body is observed
  

Potential Complications:

• - Pain when injecting phenol
• - Orthostatic hypotension