Authors report 163 cases of lumbar sympathectomy they did under local anesthesia from 1968 to 1975. All were older--and poor risk patients. Approach was always lumbar with resection of distal part of the 12th rib. If good care is taken to do anesthesia infiltration of the five lower intercostal nerves and of the 1st and 2nd posterior lumbar nerves, anesthesia is quite good, and surgery easy and painless. The main advantages are:--easy excision of the first lumbar sympathetic node through this lumbar approach;--low lethality as far as authors consider almost no contra-indications;--very fast recovery of bowel movements;--immediate oral feeding which is important for diabetic patients;--no tracheal, bronchial or lung postoperative infestation or trouble. Patients have never had any trouble (convulsions) from lignocaine since gardenal is given in pre-anesthesia.