L L IschemiaNCT06073795
Ultrasongraphy Versus Fluoroscopy in Lumber Sympathetic Block in Chronic Lower Limb Ischemia
An observational study of L L Ischemia, run by Assiut University.
Trial summary
The aim of this study is to compare total procedure time and success rate between FL-guided and US-assisted LSGBs in Lower Limb Ischemic patients. Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- L L Ischemia
- What is being tested?
- sympathetic block
- Type of treatment
- Surgery or procedure
- How many people
- 60 participants
- Where
- No sites listed yet
- Study dates
- 1 Nov 2023to 1 Dec 2025
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- Adult, Older adult
Study population: Lower Limb Ischemic patients need LSGB procedures
Who may be able to join
- • Lower Limb Ischemic patients need LSGB procedures
Who cannot join
- • A body mass index (BMI) of >30 kg/m2.
- A history of post-lumbar laminectomy with internal fixation or any severe anatomic variation, such as scoliosis and tumor.
- History of lumbar sympathetic chemical or thermal neurolysis.
- Pregnancy.
- Infection at the puncture site.
- Coagulopathy.
- Allergy to local anesthetics.
Trial locations and contacts
No sites are listed yet.
About this study
Official title: Ultrasound Guided Versus Fluoroscopy Guided Lumber Sympathetic Block in Chronic Lower Limb Ischemia
The aim of this study is to compare total procedure time and success rate between FL-guided and US-assisted LSGBs in Lower Limb Ischemic patients.
Read the detailed description
Morbidity and death in acute lower limb arterial occlusion are well described. The patients often are in a debilitated state, with multiple concurrent medical comorbidities. An association with hypercoagulable phenomena (e.g., active malignancy) may explain the frequency of some of these conditions. Other conditions, however, may be directly responsible for the occlusive event itself (e.g., the association of myocardial disease and peripheral embolization) (1, 2).
The sympathetic nervous system controls many of the involuntary functions of the human body and plays a role in chronic pain conditions such as complex regional pain syndrome (CRPS) (3).
About 20% of patients who suffered lower limb ischemic pain are not suitable for surgical intervention for various reasons. In these patients, a lumbar sympathetic ganglion block (LSGB) can be used to reduce pain, improve the walking status and activities of daily living, and may delay or avoid amputation. LSGB technique has become increasingly popular in recent decades, and several diseases are treated with LSGB, including neuropathic pain (NP), vascular pain, and erythematous extremity pain (4).
An LSGB refers to injecting drugs (local anesthetic drugs: lidocaine, ropivacaine, etc.) into the lumbar sympathetic ganglia of the corresponding segment to destroy the nerve conduction function, thereby achieving the method of treating certain diseases. The use of LSGB can destroy the innervation of sympathetic nerves on the blood vessels of the lower extremities, and the innervated blood vessels continue to expand to improve local blood circulation and nutrient supply, thereby reducing pain (5).
This block is typically performed in the prone position at the L3 level under fluoroscopic guidance. Fluoroscopy (FL)-guided LSGB has been a popular technique, as it provided great accuracy in confirming the location of needle tip or intravascular (IV) injection. However, this technique exposes patients to radiation and its success rate ranges from 67% with FL guidance to 83% with computed tomography (CT) guidance (6).
Ultrasound (US)-guided or assisted techniques have been introduced to the field of pain medicine in the mid- 2000s. US guidance has been shown to be associated with many advantages, including minimal radiation exposure, as well as the ability to visualize soft tissue structures and observe needle insertion and spread pattern of injectate in real time (7).
As US guidance has undergone technical advancements, its applicability expanded from peripheral blocks to deep neuraxial blocks. A recent technical description of US guidance LSGB in a patient with CRPS type I showed that the anterior fascia of the psoas muscle and the anterolateral part of vertebral body are key landmarks during the procedure (8).
US-guided LSGB in conjunction with FL, may be expected to provide real-time visualization of the needle tip location with respect to the anterior fascia of the psoas major muscle in paravertebral space with an advantage of low radiation exposure.
Recently, numerous US-assisted procedures in pain medicine have been attempted, showing an advantage of low radiation exposure (8).However, only few publications relatively few sample size manipulate the comparison between FL-guided and US-assisted LSGBs in Lower Limb Ischemic patients.
- Conditions
- L L Ischemia
- Being tested
- sympathetic block
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
sympathetic blockProcedure or surgery
LSGBs will be performed at the lower third of the L2 or the upper third of the L3 vertebra without any premedication. The targeted lumbar vertebra will be identified with an anteroposterior (AP) fluoroscopic imaging in the FL group or with an US longitudinal tracing approach from the caudad to cephalad direction in the US group. The skin entry point will be infiltrated with 1% lidocaine. Then, a curved 21 G, 15-cm Chiba needle will be advanced toward the target using the posterolateral approach in both groups. Each patient will undergo LSGBs according to the allocated group.
| Study group | Role | What they receive |
|---|---|---|
| FL group | Patients will receive FL-guided LSGB with 10 mL of 0.25% bupivacaine. Receives: Procedure: sympathetic block | |
| US group | Patients will receive US-assisted LSGB with 10 mL of 0.25% bupivacaine. Receives: Procedure: sympathetic block |
What is being measured
The primary outcome is the main question the study is designed to answer.
the total procedure time
the time from the first radiographic image for the identification of the lumbar vertebral level to the completion of the bupivacaine injection (FL group), or the time from the US probe placement on the patient's skin to the completion of the bupivacaine injection (US group).
Measured: two years
Secondary outcomes (1)
success rate
measured by vasodilatation which is measured by temperature difference between the limbs
, imaging time, onset time for temperature rise, bone touching, frequency of needle adjustment, spread pattern of contrast medium, and procedure-related complications.
Measured: two years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted10 Oct 2023
- Study start1 Nov 2023 (estimated)
- Primary completion1 Nov 2025 (estimated)
- Study completion1 Dec 2025 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (8)Papers the sponsor has linked to this study.
- Other trials for L L IschemiaStudies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 60 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Sally Ahmed kamel, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06073795
- Sponsor's protocol ID
- sympathetic block in ischemia
- Status last verified
- Oct 2023
- First submitted
- 3 Oct 2023
- Last updated
- 10 Oct 2023
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Lassandro G, Tamburrini S, Liguori C, Picchi SG, Pezzullo F, Ferrandino G, Spinetti F, Vigliotti G, Marano I, Scaglione M. Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management. Int J Environ Res Public Health. 2023 Feb 22;20(5):3868. doi: 10.3390/ijerph20053868.
PubMed 36900878Phuphanich ME, Convery QW, Nanda U, Pangarkar S. Sympathetic Blocks for Sympathetic Pain. Phys Med Rehabil Clin N Am. 2022 May;33(2):455-474. doi: 10.1016/j.pmr.2022.02.002.
PubMed 35526979Awal S, Madabushi R, Agarwal A, Singla V. CRPS: Early Lumbar Sympathetic Block is Better Compared to Other Interventions. Pain Physician. 2016 Feb;19(2):E363. No abstract available.
PubMed 26815268Samen CDK, Sutton OM, Rice AE, Zaidi MA, Siddarthan IJ, Crimmel SD, Cohen SP. Correlation Between Temperature Rise After Sympathetic Block and Pain Relief in Patients with Complex Regional Pain Syndrome. Pain Med. 2022 Sep 30;23(10):1679-1689. doi: 10.1093/pm/pnac035.
PubMed 35234922Kanao-Kanda M, Kanda H, Iida T, Kikuchi S, Azuma N. Clinical Application of Laser Speckle Flowgraphy to Assess Changes in Blood Flow to the Foot After a Lumbar Sympathetic Ganglion Block: A Case Report. J Pain Res. 2021 May 26;14:1451-1456. doi: 10.2147/JPR.S305543. eCollection 2021.
PubMed 34079360Cohen SP, Khunsriraksakul C, Yoo Y, Parker E, Samen-Akinsiku CDK, Patel N, Cohen SJ, Yuan X, Cheng J, Moon JY. Sympathetic Blocks as a Predictor for Response to Ketamine Infusion in Patients with Complex Regional Pain Syndrome: A Multicenter Study. Pain Med. 2023 Mar 1;24(3):316-324. doi: 10.1093/pm/pnac153.
PubMed 36269190Hurdle MF. Ultrasound-Guided Spinal Procedures for Pain: A Review. Phys Med Rehabil Clin N Am. 2016 Aug;27(3):673-86. doi: 10.1016/j.pmr.2016.04.011.
PubMed 27468672Ryu JH, Lee CS, Kim YC, Lee SC, Shankar H, Moon JY. Ultrasound-Assisted Versus Fluoroscopic-Guided Lumbar Sympathetic Ganglion Block: A Prospective and Randomized Study. Anesth Analg. 2018 Apr;126(4):1362-1368. doi: 10.1213/ANE.0000000000002640.
PubMed 29189275
Study at a glance
From the registry record, last updated by the sponsor on 10 Oct 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Ultrasound Guided Versus Fluoroscopy Guided Lumber Sympathetic Block in Chronic Lower Limb Ischemia
- ClinicalTrials.gov ID
- NCT06073795
- Acronym / sponsor ID
- sympathetic block in ischemia
- Conditions
- L L Ischemia
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 60 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- 1 Nov 2023 (estimated)
- Primary completion
- 1 Nov 2025 (estimated)
- Study completion
- 1 Dec 2025 (estimated)
- First posted
- 10 Oct 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The aim of this study is to compare total procedure time and success rate between FL-guided and US-assisted LSGBs in Lower Limb Ischemic patients.
Detailed description
Morbidity and death in acute lower limb arterial occlusion are well described. The patients often are in a debilitated state, with multiple concurrent medical comorbidities. An association with hypercoagulable phenomena (e.g., active malignancy) may explain the frequency of some of these conditions. Other conditions, however, may be directly responsible for the occlusive event itself (e.g., the association of myocardial disease and peripheral embolization) (1, 2).
The sympathetic nervous system controls many of the involuntary functions of the human body and plays a role in chronic pain conditions such as complex regional pain syndrome (CRPS) (3).
About 20% of patients who suffered lower limb ischemic pain are not suitable for surgical intervention for various reasons. In these patients, a lumbar sympathetic ganglion block (LSGB) can be used to reduce pain, improve the walking status and activities of daily living, and may delay or avoid amputation. LSGB technique has become increasingly popular in recent decades, and several diseases are treated with LSGB, including neuropathic pain (NP), vascular pain, and erythematous extremity pain (4).
An LSGB refers to injecting drugs (local anesthetic drugs: lidocaine, ropivacaine, etc.) into the lumbar sympathetic ganglia of the corresponding segment to destroy the nerve conduction function, thereby achieving the method of treating certain diseases. The use of LSGB can destroy the innervation of sympathetic nerves on the blood vessels of the lower extremities, and the innervated blood vessels continue to expand to improve local blood circulation and nutrient supply, thereby reducing pain (5).
This block is typically performed in the prone position at the L3 level under fluoroscopic guidance. Fluoroscopy (FL)-guided LSGB has been a popular technique, as it provided great accuracy in confirming the location of needle tip or intravascular (IV) injection. However, this technique exposes patients to radiation and its success rate ranges from 67% with FL guidance to 83% with computed tomography (CT) guidance (6).
Ultrasound (US)-guided or assisted techniques have been introduced to the field of pain medicine in the mid- 2000s. US guidance has been shown to be associated with many advantages, including minimal radiation exposure, as well as the ability to visualize soft tissue structures and observe needle insertion and spread pattern of injectate in real time (7).
As US guidance has undergone technical advancements, its applicability expanded from peripheral blocks to deep neuraxial blocks. A recent technical description of US guidance LSGB in a patient with CRPS type I showed that the anterior fascia of the psoas muscle and the anterolateral part of vertebral body are key landmarks during the procedure (8).
US-guided LSGB in conjunction with FL, may be expected to provide real-time visualization of the needle tip location with respect to the anterior fascia of the psoas major muscle in paravertebral space with an advantage of low radiation exposure.
Recently, numerous US-assisted procedures in pain medicine have been attempted, showing an advantage of low radiation exposure (8).However, only few publications relatively few sample size manipulate the comparison between FL-guided and US-assisted LSGBs in Lower Limb Ischemic patients.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| FL group | – | Procedure: sympathetic blockPatients will receive FL-guided LSGB with 10 mL of 0.25% bupivacaine. |
| US group | – | Procedure: sympathetic blockPatients will receive US-assisted LSGB with 10 mL of 0.25% bupivacaine. |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Age groups
- Adult, Older adult
- Study population
- Lower Limb Ischemic patients need LSGB procedures
Key inclusion criteria (1 listed)
- • Lower Limb Ischemic patients need LSGB procedures
Key exclusion criteria (7 listed)
- • A body mass index (BMI) of >30 kg/m2.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| sympathetic blockLSGBs will be performed at the lower third of the L2 or the upper third of the L3 vertebra without any premedication. The targeted lumbar vertebra will be identified with an anteroposterior (AP) fluoroscopic imaging in the FL group or with an US longitudinal tracing approach from the caudad to cephalad direction in the US group. The skin entry point will be infiltrated with 1% lidocaine. Then, a curved 21 G, 15-cm Chiba needle will be advanced toward the target using the posterolateral approach in both groups. Each patient will undergo LSGBs according to the allocated group. | Procedure or surgery | FL group, US group |
Primary outcome
the total procedure time
Time frame: two years
the time from the first radiographic image for the identification of the lumbar vertebral level to the completion of the bupivacaine injection (FL group), or the time from the US probe placement on the patient's skin to the completion of the bupivacaine injection (US group).
1 secondary outcome
success rate
Time frame: two years
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 10 Oct 2023.
- Background: PubMed 36900878Lassandro G, Tamburrini S, Liguori C, Picchi SG, Pezzullo F, Ferrandino G, Spinetti F, Vigliotti G, Marano I, Scaglione M. Lower Limb Ischemia as Acute Onset of Primary Aortic Occlusion: CTA Imaging and Management. Int J Environ Res Public Health. 2023 Feb 22;20(5):3868. doi: 10.3390/ijerph20053868.
- Background: PubMed 35526979Phuphanich ME, Convery QW, Nanda U, Pangarkar S. Sympathetic Blocks for Sympathetic Pain. Phys Med Rehabil Clin N Am. 2022 May;33(2):455-474. doi: 10.1016/j.pmr.2022.02.002.
- Background: PubMed 26815268Awal S, Madabushi R, Agarwal A, Singla V. CRPS: Early Lumbar Sympathetic Block is Better Compared to Other Interventions. Pain Physician. 2016 Feb;19(2):E363. No abstract available.
- Background: PubMed 35234922Samen CDK, Sutton OM, Rice AE, Zaidi MA, Siddarthan IJ, Crimmel SD, Cohen SP. Correlation Between Temperature Rise After Sympathetic Block and Pain Relief in Patients with Complex Regional Pain Syndrome. Pain Med. 2022 Sep 30;23(10):1679-1689. doi: 10.1093/pm/pnac035.
- Background: PubMed 34079360Kanao-Kanda M, Kanda H, Iida T, Kikuchi S, Azuma N. Clinical Application of Laser Speckle Flowgraphy to Assess Changes in Blood Flow to the Foot After a Lumbar Sympathetic Ganglion Block: A Case Report. J Pain Res. 2021 May 26;14:1451-1456. doi: 10.2147/JPR.S305543. eCollection 2021.
- Background: PubMed 36269190Cohen SP, Khunsriraksakul C, Yoo Y, Parker E, Samen-Akinsiku CDK, Patel N, Cohen SJ, Yuan X, Cheng J, Moon JY. Sympathetic Blocks as a Predictor for Response to Ketamine Infusion in Patients with Complex Regional Pain Syndrome: A Multicenter Study. Pain Med. 2023 Mar 1;24(3):316-324. doi: 10.1093/pm/pnac153.
- Background: PubMed 27468672Hurdle MF. Ultrasound-Guided Spinal Procedures for Pain: A Review. Phys Med Rehabil Clin N Am. 2016 Aug;27(3):673-86. doi: 10.1016/j.pmr.2016.04.011.
- Background: PubMed 29189275Ryu JH, Lee CS, Kim YC, Lee SC, Shankar H, Moon JY. Ultrasound-Assisted Versus Fluoroscopic-Guided Lumbar Sympathetic Ganglion Block: A Prospective and Randomized Study. Anesth Analg. 2018 Apr;126(4):1362-1368. doi: 10.1213/ANE.0000000000002640.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Questions about this trial
What is this clinical trial studying?
An observational study of L L Ischemia, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 10 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact sally emam, assistant lecturer (01068668302, sallyahmed720@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
the total procedure time (time frame: two years). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06073795, which also lists 8 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Oct 2023.