Lumbar Sympathetic Block
Why is this procedure performed?
A lumbar sympathetic block is used to help diagnose and treat different types of neuropathic (nerve injury or irritation) pain in your legs or feet. This type of pain is usually of burning quality and you may have sensitivity to light touch. The lumbar sympathetic ganglion is a collection of small bundles of nerves in your back. The nerves in the lumbar sympathetic ganglia are called sympathetic nerves and problems with these nerves will often cause burning pain and sensitivity in your leg or foot. A lumbar sympathetic block temporarily turns these nerves off. You may receive a repeat lumbar sympathetic block if the first was helpful. This procedure is commonly used for conditions such as reflex sympathetic dystrophy (RSD) or now known as complex regional pain syndrom (CRPS) of legs or feet.
What happens before treatment?
The doctor who will perform the injection will review your medical records and imaging studies to plan for the best location for these injections. Patients who are taking aspirin or blood thinners may need to stop taking the several days before your epidural steroid injection, doctor will provide specific instructions. Discuss any medications with your doctors, including the one who prescribed them and the doctor who will perform the injection. The injection is usually performed in an outpatient procedures suite that has access to fluoroscopy. You will need make arrangements to have someone drive you to and from the office or outpatient center the day of the injection.
What happens during treatment?
Before your injection, you will be asked to sign consent forms, list medications you are taking, and list any allergies to medications. Procedure may last 15-30 minutes followed by a recovery period. Patients remain awake for these procedures. Sedatives can be given to help lessen anxiety. The patient will be lying face down on the table, will receive a local anesthetic, which will numb the skin before the injection is given. If IV sedation is used, your blood pressure, heart rate and breathing will be monitored during the procedure. With the aid of a fluoroscope (a special X-ray), the doctor will direct a hollow needle through the skin and muscles of your back next to the spine on the affected side. More than one needle may be used. Fluoroscopy allows the doctor to watch the needle in real-time on the fluoroscope monitor to make sure that the needle goes into correct location. When the needle is in the right position, local anesthetic will be injected into the lumbar sympathetic ganglia to "turn off" the nerves. Contrast agent is injected to confirm correct needle position and desired medication spread along the spine. Some discomfort may occur, but patients typically feel more pressure than pain. The needle(s) are removed at the end of the procedure.
What happens after treatment?
Most patients can walk immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home. Typically patients will resume full activity the next day. If soreness around the injection site is present the following day, it may be relieved by using ice and taking mild pain medications such as Tylenol. The doctor’s office may want to follow up with you 7 to 14 days after the procedure to assess you response to this injection. You may be provided a diary to record you response to this procedure. After the lumbar sympathetic block is performed you will notice certain symptoms that may be present for up to 8-12 hours. You may notice increased warmth and redness of the leg and foot. Rarely, you may have some numbness or weakness of the leg or foot. Again, these symptoms are only temporary and will go away in time. You will need to avoid the following activities until these sensations have passed: walking, climbing, driving and any exertion. Most importantly, we want to know if your pain is improved and to what extent. It is not uncommon to have complete pain relief, only partial relief or no relief at all. You may experience a small amount of bruising, bleeding or swelling at the injection site. It is best to apply ice compresses in the first 24 hours followed by heat after 24 hours in short durations, usually 20 minutes at a time. Please continue regular medications. If you are experiencing other difficulties or side effects please call our office so that we may recommend further action or please go to the nearest emergency room for evaluation.
What are the risks?
The potential risks associated with inserting the needle include bleeding, infection, allergic reaction, headache, and nerve damage (rare), corticosteroid medication induced side effects such as weight gain, water retention, flushing (hot flashes), mood swings or insomnia, and elevated blood sugar levels in diabetics. These usually resolve within 3 days. Patients who are being treated for chronic conditions (e.g. heart disease, diabetes, rheumatoid arthritis, or those who cannot temporarily discontinue anti-clotting medication) should consult their personal physician for a risk assessment. With few risks, epidural steriod injections are considered an appropriate nonsurgical treatment for some patients.