Lumbar (Waist) Sympathetic Nerve Block

         Lumbar sympathetic block is a type of block that can help relieve chronic leg and foot pain caused by conditions such as complex regional pain syndrome, reflex sympathetic dystrophy, vascular insufficiency and shingles. The drugs are administered to a chain of ganglia located on either side of the spine called the sympathetic nerves. The goal is to reduce pain so you can resume normal activities and physical therapy.

       Sympathetic nerves are part of the autonomic nervous system that controls our “fight or flight” response. They increase heart rate, sweating, and blood pressure, while decreasing peripheral blood flow. Sometimes these nerves can begin to transmit pain after an injury.

      During this minimally invasive procedure, a local anesthetic (lidocaine or bupivacaine) and corticosteroid (betamethasone, triamcinolone or dexamethasone) may be injected into the sympathetic nerves in this lumbar region. The drugs are administered to the sympathetic nerve ganglia adjacent to the L2, L3 and L4 vertebrae. Lumbar sympathetic block can be diagnostic and therapeutic

   You can benefit from sympathetic nerve block if you have one of the following chronic pains:

1. Complex regional pain syndrome Type 1 (Reflex sympathetic dystrophy)

2. Complex regional pain syndrome Type 2

3. Ischemic pain caused by vascular occlusion in the legs

4. Phantom limb pain (Phantom syndrome)

5. Herpes zoster infection of the legs (shingles)

6. Painful diabetic neuropathy in the legs (if not relieved by drugs)

      First, your medical history and imaging will be reviewed to plan the best approach for your injection. Patients using blood thinners (warfarin, rivaroxaban, etc.) may need to stop taking them a few days before the procedure. The procedure should not be performed if you have an infection, pregnancy or bleeding problem. Close follow-up of patients with glaucoma, diabetes and hypertension is important after the procedure.

       Injection is a day-long procedure, usually accompanied by fluoroscopy. The patient is discharged 3 hours after the procedure. After the patient lies face down on the fluoroscopy (X-ray) table, a low dose of sedative medication such as midazolam is administered. After cleaning the lumbar region with an antiseptic solution, local anesthetic is injected to numb the skin. The fluoroscope allows the physician to monitor needle movement in real time on a monitor. In the procedure, the needle is directed towards the lumbar sympathetic ganglion under fluoroscopic (x-ray) guidance. Contrast dye is injected to ensure the needle is in the correct placement. After the correct placement of the needle is confirmed, the drug is injected, the needle is removed and the procedure is terminated.

      You may feel warmth or fullness in the affected leg after the procedure. There may also be temporary numbness or loss of strength in the limb. You can be discharged when you can walk comfortably.

     A lumbar sympathetic nerve block is a relatively safe procedure with minimal risk of complications. The risks of lumbar sympathetic block include bleeding, infection, allergic reaction, nerve damage, paralysis, drop in blood pressure, anaesthetic toxicity, hematuria (blood in the urine), numbness, and fatigue.

       Many patients benefit from the procedure. Generally, patients may require several lumbar sympathetic blocks to achieve long-term results. The timing of the procedures is determined by the results of the treatment.