Lumbar Sympathetic Block

INDICATION:

This procedure is performed to relieve leg pain caused by complex regional pain syndromes (CRPS), which may develop after an injury to a joint or limb. Usually a series of injections are needed to treat the problem.

PROCEDURE:

Patients lie either on their side or stomach on a table equipped with a special x-ray (fluoroscopic) unit, and an intravenous (IV) line is started to administer medication to relax the patient. A local anesthetic numbs the skin and tissue down to the sympathetic nerves.

The physician slides a needle through the anesthetized track. A contrast solution is injected. The physician uses a fluoroscope to identify the painful areas and to confirm the correct location of the needle tip.

Next, a mixture of anesthetic, saline and anti-inflammatory medicine is injected around the sympathetic nerves to block pain signals from reaching the brain.

At the end of the procedure: The legs may feel weak or numb for a few hours after the procedure.

Then, pain from the legs should decrease. More blocks may be repeated about once a week until the pain subsides. Patients who are on blood- thinning medications or who have an infection near the injection site should not receive the block.

What is a lumbar sympathetic block ?
(Over View)

A lumbar sympathetic block is an injection of local anesthetic into the back using X-ray guidance. With this procedure, we are blocking the sympathetic nerves to your leg. These nerves typically are not responsible for sensation, but they can be "turned on" in certain pain syndromes.

This procedure is typically ordered by your doctor for pain located in the buttocks and/or legs that is caused by sympathetically maintained pain, or complex regional pain syndrome, formerly known as reflex sympathetic dystrophy (RSD). It may also be ordered for nerve injury or post-herpetic neuralgia (herpes zoster, shingles). Lumbar sympathetic blocks are also used with circulation problems (e.g., vascular insufficiency) to see if blood flow can be improved.

Lumbar sympathetic blocks may have therapeutic or diagnostic value. One of two things will happen: The pain does not go away, and there is evidence of a sympathetic block. The fact that the pain is unresponsive to sympathetic blocks is of diagnostic value.

The pain goes away after the injection and stays away longer than the life of the local anesthetic. This means the block was of therapeutic value.

This procedure will most likely have to be repeated to produce a long-lasting benefit. The spacing of injections will be based on how long the pain relief lasts between injections. Typically, you will experience a longer benefit following each subsequent injection. We also may decide to "destroy" the sympathetic ganglion using radiofrequency energy if you obtained excellent, but temporary, relief.