Lumbar Sympathetic Block

What is a lumbar sympathetic block?

A lumbar sympathetic block is an injection that is designed to help patients that have “sympathetically mediated” pain in areas of the body below the waist. The nerves that are being targeted are located on either side of the spine in the lower back.

What is the purpose of a lumbar sympathetic block?

Certain pain syndromes are associated with diseases of the sympathetic nervous system. These include Complex Regional Pain Syndrome (CRPS), neuropathy, peripheral vascular disease, herpes zoster and other sympathetically maintained pain syndromes. When these types of diseases are affecting the areas of your body below the waist into your legs, a lumbar sympathetic block can be performed to help with both diagnosis as well as treatment. A lumbar sympathetic block can potentially reduce the pain and swelling as well as improve the color and normalize the skin, sweat and hair changes in the affected region.

How long does the lumbar sympathetic block take?

A lumbar sympathetic block takes from ten to thirty minutes to complete.

What is actually injected?

The injection consists of a local anesthetic. On occasion, we may also add other medications to the injection, including epinephrine, clonidine or a steroid medication to prolong the beneficial effects of the block.

Will the lumbar sympathetic block hurt?

Prior to the joint injection, we use numbing medicine at the skin using a very thin needle. This often feels like a “pinch and a burn” to numb the skin before entering the deeper tissues and joint capsule. Patients also receive intravenous sedation for their comfort during the procedure as well.

Will I be “put out” for the lumbar sympathetic block?

Typically not. This procedure can often be completed under local anesthesia with intravenous sedation. The amount of medication for sedation is titrated in carefully to achieve comfort with the minimal amount of medication necessary.

How is the lumbar sympathetic block performed?

The procedure is done with the patients lying on their belly. Monitors, such as EKG, blood pressure cuff and oximeter are placed and oxygen is typically given through the nose. The skin over the injection site is cleaned with antiseptic solution and the skin is then numbed with local anesthesia. The lumbar sympathetic block is performed under X-ray guidance for precise needle placement. After a test dose is given, the injection is given over several minutes. The needle is then removed and a bandage is applied.

What should I expect after the lumbar sympathetic block?

The lumbar sympathetic block may cause your legs to feel warm, numb and temporarily weak, although the latter two are not desired or intended effects of the injection. Overall, you may feel immediate complete or partial pain relief in the area where pain was once felt.

What should I do after the lumbar sympathetic block?

We recommend you have a ride home and take it easy for the rest of the day (and possibly also the next day) after the procedure. Take it easy and slowly increase your activity level as tolerated. Your physician may ask you to begin physical therapy immediately.

Can I go to work to work the next day?

Unless there are any complications or side effects, you should be able to return to work the next day. You may experience soreness at the injection site for up to a few days after the procedure. We recommend you increase your activity level gradually.

How long does the effect of the medication last?

Although the local numbing medicine wears off in just a few hours, the lumbar sympathetic block lasts several hours. The overall duration of relief should get longer and longer after each subsequent injection.

How many lumbar sympathetic blocks do I need to have?

It depends on how you respond to the first injection. If you respond well to the first lumbar sympathetic block, we typically recommend you schedule a series of injections to lengthen the duration of pain relief. Patients who have early and mild symptoms may need 2 to 4 injections where patients who have chronic, severe symptoms sometimes may need more than 10.
The response to such injections varies from patient to patient.

Will the lumbar sympathetic block help me?

It is difficult to predict with 100% accuracy how a patient will respond to a joint injection. However, patients who typically have pain that is milder and has been present for a shorter amount of time generally respond better than those with more severe, long standing pain.

Patients in the advanced stages of disease may not respond adequately.

Joint injections are generally very safe procedures. The most common side effect of the procedure is pain and soreness, which typically subsides with time. Other, more rare, risks include infection, bleeding and worsening of symptoms. There are risks also associated with the medications that are injected as well. For instance, steroids could cause weight gain, increase in blood sugar and the suppression of the body’s own ability to produce cortisone. Serious side effects are uncommon.

What are the risks and side effects of a lumbar sympathetic block?

The lumbar sympathetic block is a safe procedures. The most common side effect of the procedure is pain and soreness, which typically subsides with time. Other, more rare, risks include infection, bleeding, worsening of symptoms spinal block epidural block or injection into blood vessels or surrounding organs. Fortunately, the serious side effects and complications are uncommon.

Who should not have a lumbar sympathetic block?

Patients who have an allergy to any of the medications that are injected, are on blood thinners as a part of their medication regimen, have an active infection or have poorly controlled diagnoses such as diabetes or heart disease may not be good candidates for a joint injection. Your physician will determine whether you are a safe candidate.

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