A lumbar sympathetic block is an injection of local anesthetic into the back using X-ray guidance. With this procedure, we are blocking the sympathetic nerves to your leg. These nerves typically are not responsible for sensation, but they can be "turned on" in certain pain syndromes. This procedure is typically ordered by your doctor for pain located in the buttocks and/or legs that is caused by sympathetically maintained pain, or complex regional pain syndrome, formerly known as reflex sympathetic dystrophy (RSD). It may also be ordered for nerve injury or post-herpetic neuralgia (herpes zoster, shingles). Lumbar sympathetic blocks are also used with circulation problems (e.g., vascular insufficiency) to see if blood flow can be improved. Lumbar sympathetic blocks may have therapeutic or diagnostic value. One of two things will happen:
This procedure will most likely have to be repeated to produce a long-lasting benefit. The spacing of injections will be based on how long the pain relief lasts between injections. Typically, you will experience a longer benefit following each subsequent injection. We also may decide to "destroy" the sympathetic ganglion using radiofrequency energy if you obtained excellent, but temporary, relief. Please note: This procedure cannot be performed if you have an active infection (and are on antibiotics), flu, fever, extremely high blood pressure, or if you are on blood thinners (e.g., aspirin, Coumadin, Plavix, Pletal). Blood thinners must be stopped five to seven days prior to the procedure. For your safety, please inform us if any of these conditions exists.
The risks of the procedure, though rare, include allergic reaction to the medication used, hypotension (drop in blood pressure), weakness or numbness in legs (lasting the life of the local anesthetic, or approximately four to six hours), anesthetic toxicity, nerve damage, and hematoma (blood collection). In addition, patients may sometimes temporarily notice blood in their urine, as the needle passes near the kidneys. Last, it is expected that the leg on the side of the body where the injection site is located will experience a temperature increase that lasts the life of the local anesthetic.
After you check in and sign a consent form, your vital signs will be taken and an intravenous line will be started. You also will be asked what your pain score is on a scale of 0 to 10. Then you will be taken into the procedure room. Please wear loose-fitting clothing. You may be asked to change into a hospital gown. In the procedure room, our nursing staff will position you on your stomach on a narrow table. Skin temperature monitors will be placed on your feet. Your back will be cleaned with iodine and sterilely draped. The doctor will numb your skin with a small needle, which will sting just a bit. It is very important that you hold still and let us know if we are causing you discomfort. Using X-ray guidance, the needle is then advanced to the appropriate location. A dye may be injected at this point. Please let the doctor know if you have any allergies to dye. Once placement is confirmed by X-ray, a local anesthetic is injected through the needle, and the needle is then removed. Your skin will be cleaned and a Band-Aid applied. (The Band-Aid may be removed the next morning). Your foot temperature will also be checked.
You will be taken to the recovery area in a wheelchair or on a stretcher. You will remain there for 15 to 30 minutes. Your foot temperature will be checked every 5 to 10 minutes and recorded, along with your vital signs. As soon as you can walk without any weakness, you can be discharged. If you have any local tenderness from the needle, ice will help relieve this discomfort. You can also resume taking your normal pain medications.
Following your procedure, you are not allowed to drive for the remainder of the day. An adult must be present to drive you home or to escort you on another form of transportation. This is for your own safety. In addition, do not go swimming or soak in a tub or Jacuzzi on the day of the procedure. Otherwise, you may do whatever you feel up to doing.
You should call us immediately at 781-744-5090 if you experience any of the following: