The lumbar sympathetic nerves are a bundle of nerves located next to the spine in the lower back. This bundle of nerves is one part of the sympathetic nervous system. The sympathetic nervous system controls blood flow, sweating, and can be involved in pain signal transmission. A lumbar sympathetic block involves the injection of a local anesthetic (lidocaine or bupivacaine) around this nerve bundle. X-ray guidance is to ensure proper placement. A lumbar sympathetic block is both diagnostic as well as therapeutic, meaning that in addition to determining the cause of your pain, the block may treat the pain problem as well. This procedure is intended to temporarily block these sympathetic nerves with local anesthetics. Blocking these nerves often resets the nerves back into their normal state, thus treating the pain syndrome. The injection may be performed once or multiple times if needed.
What conditions are treated with lumbar sympathetic blocks?
Neuropathic pain results from the inappropriate activation of sympathetic nerves. This can result from any type of injury, large or very small. These nerves can be activated and result in a chronic pain syndrome. This syndrome is referred to either as Complex Regional Pain Syndrome (CRPS I or II) that is also known as RSD (reflex sympathetic dystrophy) and Causalgia. Symptoms may include very sensitive skin, changes in color and temperature, and may be associated with severe pain. Sympathetic blocks can also help diagnosis and treat limbs with poor blood flow.
How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. The skin is cleansed with a sterilizing solution (chlorhexidine) and a sterile drape is placed. A local anesthetic medication typically (Lidocaine) is given to numb the skin. Next, fluoroscopy (x-ray) is used to find the target. A thin needle is directed to the desired location. A local anesthetic and/or steroids are then injected. During the entire procedure you will be constantly monitored by our team. After the injection a small bandage is placed on your skin. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.
What medication is injected?
The injection includes a combination of anesthetic (lidocaine or bupivacaine).
Does the procedure hurt?
The procedure is typically well tolerated. A localized burning sensation from the anesthetic is commonly felt and is usually the most uncomfortable part of the process. During the procedure a pressure sensation is often experienced this typically resolves within a few minutes. Minor soreness for a week after the procedure is normal.
How long does the procedure take?
The procedure typically takes about 15 minutes to perform. Please plan on being at the clinic for about 1 hour to allow for pre and post-procedural safety protocols.
How quickly will I get relief?
Relief should be rapid with some relief setting in within 24 hours.
How long can I expect the relief to last?
Every patient is different. Most patients get reduced pain lasting 2-4 months. Some patients can get relief lasting greater than a year or complete long-term relief.
How often can the procedure be repeated?
Depending on results and providers discretion the injections may be repeated up to 3-4 times over the course of a few months to get sustained relief.
What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.
Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.
Should I take my normal medications as scheduled?
Yes. Continue taking your prescribed medications prior to procedure.
What if I am on a blood thinner or Aspirin?
Anticoagulation is often stopped for a short period of time prior to injection. Please speak with your primary physician if you take blood thinners to make sure that you can safely stop taking these medications.
Do I need a driver?
Yes. For your safety we require a driver to ensure a safe return home.
Can I eat the day of the procedure?
It depends on the location. We recommend eating a light meal if the injection is done in our clinic. If the procedure is done at the surgery center then you must fast for at least 8 hours prior to the procedure. We do not recommend eating after procedure for 4-6 hours as sometimes the local anesthetic can cause temporary weakness and numbness of the muscle located in the neck.
Can I get sedation or anesthesia?
Most patients do well without sedation. Light sedation with oral medications is sometimes provided at the provider’s discretion.
What if I am pregnant?
There are serious potential risks to an unborn fetus when exposed to imaging studies, including x-ray and fluoroscopy. If there is any chance you may be pregnant, please postpone this procedure until it can be confirmed that you are not pregnant as it is not safe to do during pregnancy.
What should I wear?
We recommend light loose-fitting clothes. Sometimes we will ask you to change into a gown.
When can I drive after the procedure?
We recommend resuming driving the next day.
What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort.
What are my restrictions after the procedure?
We typically ask that you do not eat for 4-6 hours after the procedures at the local anesthetic can cause numbing of the muscle and nerves that help you swallow. Typically, you may resume light activities on the same day following your procedure. Physical therapy can be re-started within 24 hours. We recommend returning to work the day after the procedure.
When can I shower?
Showering the day of the procedure is allowed. For 24 hours you are asked to refrain from submerging or swimming in water. Keep the bandage on for one day.
When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We typically see patients back in 2- weeks.