What is a lumbar sympathetic nerve block?

The sympathetic nerves are a group of nerves found along the front side of the spinal column. They are part of the autonomic nervous system and control many bodily functions including sweating, heart rate, digestion, and blood pressure. Sometimes these nerves can continue to transmit pain following an injury even after the injury has healed. This can result in a condition known as Chronic Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD). Symptoms of CRPS include severe burning pain, swelling, and skin color changes.

A lumbar sympathetic nerve block is a special test to help your doctor find the cause of your symptoms. During the test, an anesthetic (numbing) medication is injected near your spine. This "blocks" the sympathetic nerves in that region. If these nerves are causing your symptoms, the injection may offer relief for a while immediately after the procedure. If effective, your doctor may recommend a series of these blocks 1-2 weeks apart which may help give you more long term pain relief.

What are the risks of the procedure?

Complications are rare but can include infection, bleeding, spinal or epidural block and injection into a blood vessel.

Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. Please make your doctor aware of any of these conditions. This is for your safety!

How do I prepare for my procedure?

No solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before arriving at the PMC. If you are taking any blood thinners such as Coumadin, Warfarin, Plavix, or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication. Please make your Pain Management doctor aware that you are taking a blood thinner, and contact your primary care physician or prescribing physician before stopping this medication.

What happens during the actual procedure?

You will be given an IV line prior to the procedure, through which you may receive fluids or a mild sedative to help you relax. You will be lying on the fluoroscopy (X-ray) table on your stomach. Your skin will be cleansed with antimicrobial soap and alcohol. You will then receive an injection of numbing medication to the skin. X-ray imaging is used by the doctors to guide placement of the needle before the injection of a local anesthetic near the sympathetic nerves. If the sympathetic nerves are causing your problem, you may experience temporary pain relief and the temperature in your painful limb will rise. Sympathetic nerve blocks may provide long-term pain relief. For this treatment, a few blocks are given 1-2 weeks apart and, if you are having physical therapy, the blocks can be scheduled to coincide with your therapy sessions.

What will happen after the procedure?

You will stay in our recovery area for an appropriate period of time, usually about 30-45 minutes, while we monitor your vital signs and the temperature of the painful leg. You will be offered juice/soda and graham crackers. You will be given verbal and written discharge instructions, and you may go home with your driver after your doctor authorizes discharge.

Note: This procedure will be cancelled if you do not have a responsible adult driver over the age of 18 to take you home or accompany you home in a taxi. This is for your safety!

Will I have any restrictions on the day of the procedure?

You may not drive for the remainder of the day. No heat is to be used over the injected area for the rest of the day. No tub bath, shower, or soaking in water (i.e., pool, hot tub, etc.) for the rest of the day. The injection site may also be swollen or sore for a few days. Using an ice pack three or four times a day may be helpful. Your regular diet and medications may be resumed after the procedure. You may resume normal activity the day after the procedure.

When Should I Call the Pain Management Center?

We would like speak to you the day after your procedure regarding your response. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain score, and if you are experiencing any problems. If you experience severe pain, new numbness or weakness of legs, a temperature of 100.5 or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call the Pain Management Center immediately at 410-448-6824 to have the pain management physician on call paged to your number.