A lumbar sympathetic nerve block is a diagnostic or therapeutic procedure. It can be used to help the doctor find the cause of your pain and symptoms, or it can be used to relieve the symptoms.
What are the sympathetic nerves?
The group of nerves that spur from the front aspect of the spinal column are called the sympathetic nerves. These nerves are components of the autonomic nervous system, and they control many bodily functions such as heart rate, blood pressure, and sweating.
What conditions are treated using the lumbar sympathetic nerve block?
The sympathetic nerves often continue to transmit pain signals long after an injury has healed. This can lead to the condition known as complex regional pain syndrome (CRPS). In addition, this block is used to treat excessive sweating, pain from blood vessel spasms, and Raynaud’s syndrome. The injections to the spinal region can be given in a series of 2-3, which are administered 1-3 weeks apart.
How do I prepare for the procedure?
When you meet with the doctor, you will have an examination, some preliminary tests, and the doctor will ask questions regarding your symptoms. Once you decide together on the lumbar sympathetic nerve block, the doctor reviews risks and benefits and has you sign a consent form. After midnight, you should have no fluids or foods until after the procedure the next day. In addition, you should leave all valuables at home, and wear loose-fitting clothing to the surgical center.
What happens during the lumbar sympathetic nerve block procedure?
Once you change into a gown, the nurse places an IV line in your arm. You are given a sedative to make you relax. After being positioned face down on the procedure table, your lower back is cleaned with an antimicrobial solution. The doctor numbs the skin using an anesthetic. The procedure needle is positioned near your sympathetic nerves using x-ray imaging. After the solution is instilled onto the nerves, the needle is removed and a bandage is placed over the site. The doctor will ask you questions about pain relief in your affected extremity.
How long does it take?
The lumbar sympathetic nerve block only takes around 10 minutes, but you will be at the medical facility for around 1 ½ hours. You have to register, see the nurse, and go to recovery following the procedure.
What happens after the procedure?
You will be monitored by a nurse in recovery for around 30 minutes. Once you are fully alert, the nurse gives you discharge instructions. You must rest the remainder of the day and gradually return to usual activities.
What medications are injected during the lumbar sympathetic nerve block?
The anesthetic used to numb the skin is lidocaine or bupivacaine. The medication instilled on the nerves could be ropivacaine or bupivacaine (anesthetics), or the doctor may use phenol or absolute alcohol (neurolytic agents). The procedure involves a slight burning sensation when the anesthetic is given. In addition, you may feel slight coolness or stinging when the agent is instilled onto the nerves.
Does the lumbar sympathetic nerve block work?
In a study involving patients with lumbar spinal stenosis with cauda equine nerve involvement, the lumbar sympathetic nerve block was performed on both sides, involving neurolysis. Following a six-month observation period, patients were asked about symptom improvement and physical function. The block was found to be effective for improving neurogenic intermittent claudication and some radicular symptoms. Another study showed this procedure to have an 88% efficacy rate.
Ifuku M, Iseki M, Hasegawa R, et al. (2013). The efficacy of lumbar sympathetic nerve block for neurogenic intermittent claudication in lumbar spinal stenosis. Indian Journal of Pain, 27(3), 159-164.