Lumbar Sympathetic Block: What Is It and How Is It Done?
Your body consists of a bundle of nerves called the sympathetic nervous system, which runs from the base of the skull to the edge of your lower back, also known as the lumbar area. Its main function is to control the flight or fight response and various involuntary body functions, such as heart rate, blood flow, and digestion.
Sympathetic nerves in the lower extremities will gather along the sides of the vertebral column on their way to the brain.
Physicians can help patients with an effective pain-relieving method called a lumbar sympathetic nerve block. In this article, our experts in pain management in Gainesville, Fl discuss everything you need to know about the procedure.
What Is a Lumbar Sympathetic Block?
A lumbar sympathetic block refers to a minimally invasive procedure in which a pain specialist will inject a local anesthetic into your lower back, onto the lumbar spine (without touching the spinal cord).
A local anesthetic agent, such as lidocaine or bupivacaine, is used for diagnostic procedures (used to confirm if the pain is connected to the sympathetic nerves). For therapeutic purposes, doctors use radiofrequency ablation for long-term pain management.
The injected local anesthetic will then target the sympathetic nerves around the lumbar area to disrupt its nerve supply and block the pain signals it was supposed to send to the brain. This can help reduce the pain sensations and inflammation in the lower extremities of the patient’s body, like the lower back, limbs, and feet.
How Is It Done?
Here is a play-by-play on how a lumbar sympathetic block procedure is done from start to finish.
Before undergoing the procedure, you will be required to disclose your medical history to the physician, such as your allergies and current medications. Additionally, you will also be advised to fast six hours prior to the procedure and have someone other than yourself take you home.
A staff member will then prepare you by asking you to lie face down on an x-ray table. Usually, the procedure is performed without sedation. You may be provided oral (a pill) sedation, if requested.
Sympathetic Block Procedure
A staff member will prepare your lower back (injection site) with a cleaning solution and cover it with sterile draping. Next, local anesthesia will be injected (using a small needle) around the proposed entry point of the procedure needle to numb the skin in the area. Then:
- Guided by a fluoroscopic C-arm operator x-ray, the physician will insert a hollow needle into the lumbar sympathetic ganglia area. It’s normal to feel some discomfort or pressure sensations in the injection site during this step.
- The clinician will then ensure that the aspiration site has no blood.
- Then, contrast will be injected to ensure proper flow so that the medication will be going to the right place.
- After that, your doctor will inject the medication used to block the lumbar sympathetic nerve supply.
Sympathetic Block Procedure Aftercare
Immediately after injecting the local anesthetic, you may feel a warming sensation in your limbs, which is normal. After the treatment, you will be advised to rest for 15 to 30 minutes.
Additionally, your doctor may recommend you take a day or two to rest and avoid swimming or soaking in the tub 72 hours after the procedure.
The whole treatment一from patient preparation to injecting the medication 一 takes less than 30 minutes. Most patients typically go back to their everyday activities the next day, with only a sore injection site left that an ice pack or Tylenol can solve.
Who Performs the Treatment?
A sympathetic block treatment is not a typical injection administration procedure. Therefore, it can only be performed by trained physicians, such as pain physicians, physiatrists, or radiologists.
How Effective Is a Lumbar Sympathetic Block?
A lumbar sympathetic block is an effective pain management procedure for patients experiencing chronic pain in the lower back and legs. In fact, a study done on individuals affected with complex regional pain syndrome yielded an 84% effectiveness in pain reduction.
Some patients experience instant pain relief from their chronic pain right after the treatment, while others feel the effects after two to three days.
For long-lasting results, your doctor may require you to undergo a series of lumbar sympathetic block procedures, which can vary from two to ten sessions.
What Are the Risks?
A lumbar sympathetic block procedure has a low risk for complications. The most common ones encountered by a number of patients include the following:
- Bruising, swelling, and soreness at the site of injection.
- Bleeding on the injected area.
- Transient weakness and numbness of the legs.
However, all these transient side effects can be resolved in a matter of hours or a few days without using medications. In addition, severe complications, like infection and injury to the site of injections, are exceedingly rare.
Individuals should not go through a sympathetic block procedure if they have specific medical conditions or undergoing certain therapies, such as:
- Allergies to medications injected.
- Poorly managed diabetes and heart disease.
- Bleeding problems.
- Anticoagulant treatment that cannot be stopped.
Who Can Benefit from a Lumbar Sympathetic Block?
According to the chronic pain management guidelines developed by the American Society of Anesthesiologists, lumbar sympathetic blocks can be used as part of the treatment plan of individuals combating pain disorders related to the sympathetic nerves. This includes:
Complex regional pain syndrome (CRPS) Type 1 (reflex sympathetic dystrophy) and Type 2 (causalgia)
This health condition refers to prolonged pain in the arm or leg area caused by an injury to the soft tissues. A person with CRPS on the limbs cannot tolerate touching or moving the affected part due to extreme pain, which is why health providers strongly agree to the use of sympathetic blocks during such conditions.
Chronic vascular insufficiency in the legs
Vascular ischemia occurs when there’s a blockage in the blood of the lower extremities, causing a restricted blood flow. Normally, doctors recommend patients with chronic lower limb ischemia undergo surgical intervention to treat the illness. However, many patients with vascular diseases don’t qualify for surgical treatments due to the risk of complications and other medical comorbidities.
In such cases, a lumbar sympathetic block can be performed to disrupt the nerve supply in the affected area. As a result, this helps reduce pain and improve the patient’s healing by dilating the small veins in the area.
Phantom limb pain
This refers to a post-amputation pain experienced by 78% of limb amputee patients. Health experts and several case studies found lumbar sympathetic block procedures to effectively relieve this residual pain in affected individuals.
Shingles in the legs
The Herpes zoster virus (causative agent of shingles) primarily targets the body’s nerve cells, which is why the large nerve bundles in the legs and groin are usually affected.
Postherpetic neuralgia (PNH)
This condition pertains to a complication caused by shingles, which causes severe burning pain to the affected area.
Besides relieving pain, doctors found lumbar sympathetic blocks helpful in improving the prognosis and quality of life of patients with PNH. In fact, 9 out of 37 patients in the study were almost wholly cured following a six-month or less treatment of sympathetic blocks in the lumbar area.
Neuropathic pain secondary to diabetes
This condition happens when the peripheral nerves sustain chronic damage caused by another disease, such as diabetes. A lumbar sympathetic block procedure can help provide patients with a sustained relief from the pain of diabetic neuropathy.
Besides its analgesic effects, studies also found it to significantly improve the blood circulation in the limb area of patients suffering from diabetic neuropathy. Thus, lumbar sympathetic therapy became a vital part of patients’ treatment plan against neuropathic pain.
Recent studies identified the effective pain-relieving benefits of lumbar sympathetic block procedures in treating cancer-related pain. According to this 2020 research, the majority of patients experience the analgesic effects of sympathetic blocks against pain in the pelvic area, lower back, abdomen, and legs caused by cancer.
Is a Lumbar Sympathetic Procedure Right for You?
As discussed above, lumbar sympathetic procedures can be done for diagnostic and therapeutic purposes. For example, if you have chronic pain in the leg, lower back, or an underlying medical condition mentioned above, then you may be a candidate for a sympathetic block treatment.
However, it is always best to consult your physician first and do the necessary screening procedures before undergoing any procedure.
Where to get a Lumbar Sympathetic Block in Florida?
At Advanced Pain Medical Center, we offer lumbar sympathetic blocks as a pain relief option for our patients. We believe in exploring all treatment options to find the one that fits your needs. Our team listens to you with compassion and care to be assured you are in the right hands.
Our physician, Dr. Stewart, is a pain specialist offering patients the achievable goals of less pain and more function. With a multitude of treatments, Dr. Stewart and his team are focused on designing personalized therapies and customized alternatives for each patient.
At Advanced Pain Medical Center, we offer high-quality services such as innovative:
- medical marijuana treatment
- pain management
- regenerative medicine
- ketamine infusion therapy
- IV therapy
- and much more!
Contact us for an appointment or with any questions you may have. We look forward to hearing from you.
The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.