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Lumbar, paravertebral sympathetic block injections with a lidocaine and contrast solution resulted in significant peridural spread of contrast solution. Bilateral, extensive peridural effusion was demonstrated by multiple roentgenographic techniques. Preliminary studies indicate that agents used in stellate block procedures also extend to the peridural space. These studies cast doubt on the specificity of sympathetic blockade techniques. The findings offer an explanation for some of the sensory and motor phenomena resulting from sympathetic blocks. Neurolytic drugs used in large volumes for sympathetic blocks cannot be assumed to always produce their effects by acting within the area of injection. Sympathetic block procedures are useful for diagnosis and treatment; however, the volume of injected agent used in sympathetic block procedures should be limited, and increased vigilance for complications which may result should be practiced.
Evans JA, Dobben GD, Gay GR. Peridural Effusion of Drugs Following Sympathetic Blockade. JAMA. 1967;200(7):573–578. doi:10.1001/jama.1967.03120200051006
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