What is a Lumbar Sympathetic Block?
Lumbar Sympathetic Block is an injection of local anesthetic in the "sympathetic nerve tissue" - the nerves which are a part of the Sympathetic Nervous System. The nerves are located in the back, on the either side of spine.
What is the purpose of it?
The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, Herpes Zoster (shingles) involving lower extremity, vascular insufficiency and peripheral neuropathy.
How long does the injection take?
The actual injection takes only a few minutes.
What is actually injected?
The injection consists of a local anesthetic (like lidocaine or bupivacaine), Epinephrine (adrenaline) and steroids.
Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (like a "flu shot") so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle.
Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia. Sometimes the patients also receive a pill given by mouth that is sedating, which makes the procedure easy to tolerate.
How is the injection performed?
It is done with the patient lying on the stomach with pillows under the hips. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes may also be placed on your feet. The skin on the back is cleaned with antiseptic solution and then the injection is carried out. Fluoroscopy (X-rays) is used to guide the needle(s) in the proper position.
What should I expect after the injection?
Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some weakness and/or numbness in the leg which is only temporary.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.
Can I go to work to work the next day?
Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck at the injection site.
How long does the effect of the medication last?
The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours, days or weeks. Usually, the duration of relief gets longer after each injection.
How many injections do I need to have?
If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.
Will the Lumbar Sympathetic Block help me?
It is very difficult to predict if the injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms. Patients in the advanced stages of disease may not respond adequately.
What are the risks and side effects?
This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain - which is temporary. The other risk involves bleeding, infection, spinal block, epidural block, and injection of the local anesthetics directly into blood vessels (seizure, Arrhythmias) and surrounding organs. Fortunately, the serious side effects and complications are uncommon.
Who should not have this injection?
If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin®, Plavix®, Ticlid®), or if you have an active infection going on near the injection site, you should not have the injection.
