FAQs on Lumbar Sympathetic Block in Nashville TN

A lumbar sympathetic nerve block is a special test used to diagnose the cause of low back pain and leg symptoms, and also treat numerous conditions like RSD. The sympathetic nerves are found along the front region of the spinal column. These nerves are part of the autonomic nervous system, which controls certain bodily functions like digestion, sweating, and blood pressure.

Why is the lumbar sympathetic nerve block done?

The sympathetic nerves can continue to send pain signals after an injury, even when the damage has healed and the injury has resolved. This results in a condition known as complex regional pain syndrome, also called reflex sympathetic dystrophy (RSD).

The lumbar sympathetic nerve block helps the doctor determine if the sympathetic nerves are causing your symptoms. With this block, one of two things happen: the pain does not go away, revealing that pain is not related to the sympathetic nerves (diagnostic), or the pain goes away and stays gone for a while (therapeutic).

How many lumbar sympathetic nerve blocks are needed?

The number of lumbar sympathetic injection procedures necessary will depend on your condition. The procedure sometimes needs to be repeated to produce a long-lasting benefit. Many patients experience a longer benefit after the second injection. In addition, the doctor may use radiofrequency energy or a neurolytic agent to destroy a portion of the nerves for long-term pain relief.

What should I do to prepare for the procedure?

The lumbar sympathetic nerve block will not be performed if you have an active infection, poorly controlled blood pressure or diabetes, or a bleeding condition. If you are on blood-thinning medications, the medicine should be stopped 5-7 days prior to the procedure. Once you arrive at the medical center, a nurse will explain the procedure to you, discuss the risks and benefits, and have you sign a consent form. An IV catheter will be placed in your arm or hand, as you may require a mild sedative. In addition, you should bring someone to drive you home after the procedure.

How is the lumbar sympathetic nerve block performed?

Once you are taken to the procedure room, the staff will attach monitors to assess vital signs and position you on your stomach. The doctor cleanses the skin using an antiseptic solution before numbing the procedure area with a small needle and anesthetic. Once the tissues are numb, the doctor positions a needle near the lumbar sympathetic nerves under x-ray guidance (fluoroscopy), and verifies placement by injecting contrast dye. A long-acting anesthetic is injected near the nerves, and if necessary, the doctor will use radiofrequency or a neurolytic agent to destroy the nerves.

What should I expect after the lumbar sympathetic block?

After the procedure, you will be taken to a recovery area, where a nurse will monitor you for approximately 30 minutes. You will be given written discharge instructions, and must not do strenuous activity for the remainder of the day. In addition, you should avoid soaking in a tub or showering on the day of the procedure. The injection site will be tender for 24-48 hours, but this is easily relieved with ice packs applied to the affected region.

What side effects, complications, and risks are associated with the lumbar sympathetic block?

The side effects associated with lumbar sympathetic nerve block procedure include leg weakness, low blood pressure, and dizziness. However, these symptoms are only temporary. While complications rarely occur, they include allergic reaction to medications or contrast dye, infection, bleeding, and injection site. As with any minimally invasive procedure, there is a slight risk for nerve damage and vessel injury.

What is the success rate of the lumbar sympathetic nerve block?

Many clinical studies have examined the effectiveness of sympathetic nerve blocks. The success rate for the lumbar sympathetic block is between 70-80%, with this block boosting quality of life and providing pain relief in studies of patients with pelvic and abdominal pain. In one study out of Japan, patients reported less pain intensity and lowered opioid consumption with the lumbar sympathetic nerve block.

Resources

Datta S, Everett CR, Trescot AM, et al. (2007). An updated systematic review of the diagnostic utility of selective nerve root blocks. Pain Physician, 10(1): 113-128.

de Oliveira R, dos Reis MP, & Prado WA.(2004). The effects of early or late neurolytic sympathetic plexus block on the management of abdominal or pelvic cancer pain. Pain, 110(1-2), 400-8.

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.

Tei Y, Morita T, Nakaho T, Takigawa C, Higuchi A, et al. (2008). Treatment efficacy of neural blockade in specialized palliative care services in Japan: a multicenter audit survey. J Pain Symptom Management, 36(5), 461-7.