FAQ’s on Lumbar Sympathetic Block in Philadelphia

A lumbar sympathetic block is an injection of a long-acting anesthetic onto sympathetic nerves of the lower back. This is done to relieve pain associated with the lower back, buttocks, and/or legs. For long-term relief, a corticosteroid is often added, to decrease inflammation.

What are the lumbar sympathetic nerves?

The sympathetic nervous system arises from the lower back (lumbar) and middle back (thoracic) spine regions. The nerves of these structures run in a parallel fashion along the spine. Lumbar sympathetic nerves emit pain signals, even after they heal following nerve irritation or injury.

What happens before the lumbar sympathetic block procedure?

After a discussion with the doctor concerning the risks and benefits of the lumbar sympathetic block, you must sign an informed consent form. When you arrive at the medical facility, you must change into a gown. A nurse will place an IV catheter in your arm to administer sedatives and fluids, and monitoring devices are attached to assess blood pressure, heart rate, and oxygen level.

How is the lumbar sympathetic block performed?

After positioning you on your stomach with pillows for support, the skin is cleansed with an antiseptic solution. A local anesthetic is used to numb the skin of the lower back. Using x-ray guidance, the doctor inserts a needle near the sympathetic nerves. To confirm needle placement, contrast dye is injected. The medication is injected onto the nerves, and the needle is removed. The procedure only takes around 20 minutes to perform.

What happens after the procedure?

Following the procedure, you will be monitored for 30-40 minutes. Many patients report soreness at the injection site, and a numb sensation running down the legs. These are temporary side effects. Be sure to have someone with you to drive you home, and you must rest for the remainder of the day. You can gradually return to activities as tolerated.

What complications are associated with the lumbar sympathetic block?

The most prevalent complications are bruising and tenderness at the injection site. Uncommon risks include nerve damage, allergic reaction to contrast dye or medication, bleeding, infection, and low blood pressure.

Who cannot have a lumbar sympathetic block?

The lumbar sympathetic block cannot be performed if the patient:

  • Has an active infection
  • Has uncontrolled diabetes or heart condition
  • Is taking blood-thinning medications (Coumadin, Plavix, Pletal)
  • As an allergy to anesthetics, clonidine, and/or adrenaline
  • Has a bleeding disorder
  • Has a high fever

What conditions are treated with the lumbar sympathetic block?

The lumbar sympathetic block is used to treat:

  • Neuropathy (nerve disease)
  • Complex regional pain syndrome (CRPS)
  • Vascular insufficiency
  • Shingles and post-herpetic neuralgia
  • Pain associated with malignancies
  • Chronic pelvic pain

Is the lumbar sympathetic nerve block effective?

In a recent study of patients who were suffering from lumbar spinal stenosis and radiculopathy, the lumbar sympathetic block was found to improve symptoms and physical function. Patients reported that the results lasted 1-2 months following the procedure. Other clinical research reports show a success rate of 80% for this procedure when used to treat CRPS and neuropathy.

Resources

Bottger E, Diehlmann K. Selected interventional methods for the treatment of chronic pain: Part 1: peripheral nerve block and sympathetic block. Deratology Anaesthesist. 2011;60(5):479-491;quiz 492.

Hong JH, Kim AR, Lee MY, Kim YC, Oh MJ. A prospective evaluation of psoas muscle and intravascular injection in lumbar sympathetic ganglion block. Anesthesia and analgesia. 2010;111(3):802-807.

Hong JH, Oh MJ. Comparison of multilevel with single level injection during lumbar sympathetic ganglion block: Efficacy of sympatholysis and incidence of psoas muscle injection. The Korean journal of pain. 2010;23(2):131-136.

Ifuku,M., Iseki, M., Haseqawa, R., Morita, Y. et al. (2013). The efficacy of lumbar sympathetic nerve block for neurogenic intermittent claudication in lumbar spinal stenosis. Indian Journal of Pain, 27(3), 159-164.

Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am, 88(8):1722-1725.