Lumbar Sympathetic Blocks
The lumbar sympathetic (nerve) chain is located along the anterior (front) surface of the lumbar vertebral bodies and contains nerve fibers to the pelvis and lower extremities. The lumbar sympathetic block is a therapeutic procedure utilized for pain conditions that are sympathetically mediated (i.e. Complex Regional Pain Syndrome, Phantom Limb Pain, or even Cancer Pain). Additionally, the sympathetic block may be for diagnostic or prognostic purposes as well.
ARE LUMBAR SYMPATHETIC BLOCKS RIGHT FOR ME?
HOW DO LUMBAR SYMPATHETIC BLOCKS WORK TO CONTROL MY PAIN?
After careful placement of the needle through the back (using fluoroscopic guidance), to the anterolateral surface of the L2,3,and L4 vertebral body and confirmed location using contrast dye, therapeutic medication is injected incrementally. The injectate disrupts the communication of the sympathetic nerves and thus sympathetically mediated pain (and also vascular constriction of the lower extremity vasculature).
PREPARING FOR TREATMENT
HOW DO I PREPARE FOR THE PROCEDURE?
During the consultation with your pain management consultant, please discuss your daily medications such as blood thinners, pain medications, and any health conditions or health history. If sedation is required for the procedure, you will be given instructions on when to stop consuming food or drink.
WHAT CAN I EXPECT AFTER THE PROCEDURE?
After the sympathetic blockade, you will need to be monitored in the postoperative area to ensure appropriate increase in extremity temperature (verifying successful block) and for hemodynamic stability. If sedation is used for the procedure, the rest of the day will likely entail rest and relaxation as you recover from the sedation. The following day, normal activities may be resumed if specified by your pain physician.
In addition to an oral regimen and physical therapy regimen discussed with your pain physician, Lumbar Sympathetic Blocks may need to be repeated either frequently or infrequently depending on their therapeutic benefit and duration of action. This procedure is not only designed to disrupt the sympathetically mediated pain signaling, but also allow for overall improvement of quality of life in conjunction with your overall pain regimen.
Common Conditions Treated by Lumbar Sympathetic Blocks
- Complex Regional Pain Syndrome (Type I and II)
- Phantom Pain
- Arterial Insufficiency of Lower Extremity
- Raynaud’s Syndrome
- Herpes Zoster
- Lower Extremity Crush Injury