Lumbar Sympathetic Block
What is Lumbar Sympathetic Block?
Lumbar Sympathetic Block is an injection of local anesthetic in the “sympathetic nerve tissue”- the nerves which are a part of the Sympathetic Nervous system. The nerves are located on either side of the spine, in the back.
What is the purpose of it?
The injection blocks the Sympathetic Nerves. This can help patients with “neuropathic pain”… pain from nerves. It can also help reduce swelling, color and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, Herpes Zoster (shingles) involving lower extremity, peripheral nerve injuries, or conditions causing leg swelling.
How is the injection performed?
It is done either while lying on your stomach or on your side. You are monitored with blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes may also placed on your feet. Your back is cleaned with antiseptic solution and then the injection is carried out. Fluroscopy (x-rays) is used to guide the needle(s) in the proper position.
How long does the procedure take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a local anesthetic (like lidocaine or bupivicaine). No steroid.
What does it feel like afterwards?
Your leg and foot may feel warm and dry. You may notice that your usual pain may be gone or considerably less. There may be some groin pain and low back pain from the injection, almost always very mild. There is no leg numbness or weakness unless some of the local anesthetic has leaked onto the lumbar nerves. This happens 10% of the time. If there is leg numbness or weakness, it will last 1-6 hours and you must be very careful, because the leg may not support your weight. Do not drive until numbness is gone. In addition, report this to the nurse immediately, so arrangements can be made to prevent falls.
Will the procedure hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a “tetanus shot”). So, there is some discomfort involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. There may be back and groin soreness afterward for up to several days.
Will I be “put out” for this procedure?
No. This procedure is done under local anesthesia. You should have a ride home. We advise patients to take it easy the day of the procedure, stay off work that day. Perform normal activities as you can tolerate them. If your leg is numb, be very careful because it may not support your weight, and do not drive until numbness is gone. Some patients may go for immediate physical therapy, and this is OK. It is usually OK to return to work the day after the procedure. You may be asked to keep a Pain Log to record exactly how much pain relief you have in the early period after the injection.
Can I go to work the next day?
Unless there are complications, you should be able to return to your work the next day.
How long will the effects of the procedure last?
The local anesthetic wears off in a few hours. However, the blockage of sympathetic nerves may last for many hours or days. You may be asked to keep a Pain Log. Fill it out as directed at the time of the block.
How many procedures do I need to have?
If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need 2 or more. The response to such injections varies from patient to patient.
What are the risks and side effects?
This procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve bleeding, infections, spinal block and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon. Some patient can get light-headed when they stand up in the first 6 hours after the injection, so there should always be someone to assist you in the first 6 hours, and a place to sit quickly.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you have taken blood thinning medications (e.g. Coumadin, Plavix, Heparin) within 5 days of the procedure, if you have an active infection going on near the injection site, or if you are pregnant , you should not have the injection.