Lumbar Sympathetic Block

The sympathetic nerves lie along the front aspect of the spinal column. These nerves are components of the autonomic nervous system, which controls body functions such as heart rate, sweating, blood pressure, and digestion. A lumbar sympathetic block is procedure done to block pain signals from the sympathetic nerves.

What conditions are treated with sympathetic nerve blocks?

The lumbar sympathetic block is used for chronic regional pain syndrome (CRPS), which is also known as reflex sympathetic dystrophy (RSD). This is a condition where pain signals continue to be transmitted even after the injury or problem has resolved or healed. In addition, this block is used for chronic foot and/or leg pain, peripheral vascular disease, diabetic neuropathy, and other conditions related to the sympathetic nerves.

What are the risks and complications of the lumbar sympathetic block?

As with all minimally invasive procedures, risks and complications do sometimes occur. Although rare, these include bleeding, infection, injury to a blood vessel, injury to nerves, and worsening of pain. For precautions, this procedure is not performed on patients who have an active infection, fever, high blood pressure, or those on blood-thinning agent, such as Coumadin and Plavix.

How many lumbar sympathetic nerve blocks will I need?

If effective, the doctor may recommend a series of lumbar sympathetic blocks for long-term pain relief. These injections are given 1-2 weeks apart.

How do I prepare for this procedure?

Because a mild sedative is given, you should not have solid food or fluids after midnight before the procedure. You are permitted to take necessary medications with a small amount of water, however. Notify the doctor of all medications you are on before the block, so he can tell you which ones should be held. At the clinic, a nurse will explain the pros and cons of the procedure, and you must then sign an informed consent form. In addition, an IV catheter will be placed in your arm and monitoring devices are used to check heart rate, oxygen level, and blood pressure.

What happens during the sympathetic block procedure?

The nurse will first give you fluids and a mild sedative through the IV catheter. You are positioned on the table face down, with pillows to support your abdominal region. The lower back skin is cleansed sing antiseptic and thennumbed with an anesthetic. The procedure needle is inserted near the lumbar sympathetic nerves withx-ray guidance. The doctor will inject a lasting anesthetic onto the nerves, and you may experience immediate pain relief. Once the needle is removed, the injection site is covered with a bandage.

After the procedure is done, what can I expect?

You will remain in the recovery area for 30-40 minutes, where a nurse monitors your vital signs and the affected leg. In addition, you are given juice, soda, or another drink in addition to crackers. After being given discharge instructions, you are free to go home, but you should arrange to have someone drive. We recommend rest for the day and possibly, the following day. You are free to return to regular activities in a couple of days. No heat is to be used on the injection site, and you should not take a shower, bath, or swim for the rest of the day. Expect site soreness, which is relieved with an ice pack applied 4-5 times each day.

Does the lumbar sympathetic block work?

According to clinical studies, the lumbar sympathetic nerve block has an efficacy rate of approximately 80%. Researchers report good evidence supporting this block for neuropathic pain and CRPS.