FAQs on Lumbar Sympathetic Block

The lumbar sympathetic block involves injecting a long-acting anesthetic, and possibly, a corticosteroid onto the lower back sympathetic nerves. This treatment is used to relieve pain associated with the low back, as well as radiculopathy (pain of the legs and feet.

What are the lumbar sympathetic nerves?

The sympathetic nervous system arises in the middle (thoracic) and lower (lumbar) spine regions. These nerves run in a parallel manner along the spinal column. The lumbar sympathetic nerves become irritated or inflamed with nerve root compression.

What can I expect before the sympathetic block procedure?

The doctor will first discuss the benefits and risks of this procedure and ask you to sign a form of informed consent. When you arrive at the medical center, a nurse has you change into a gown and positions an IV line in your arm. Monitoring devices are attached to your body to assess oxygen level, heart rate, and blood pressure. Be sure to notify the doctor a week beforehand regarding all medications you are taking, as certain ones may be held for several days. Because a sedative is often given, you will need to arrange a ride home.

How is the lumbar sympathetic block done?

You will be positioned on your stomach using pillows for support. The skin is cleaned with an antiseptic solution, and a local anesthetic is used to numb the lower back region skin and deeper tissues. Using x-ray imaging, the needle is guided near the sympathetic nerves, and contrast dye is used to confirm needle placement. Once the medications are injected onto the nerves, the doctor removes the needle and places a dry bandage over the area. From start to finish, the procedure only takes around 20 minutes.

What can I expect after the sympathetic lumbar block procedure?

After the procedure, a nurse will monitor you for around 30 minutes. Expect a numb sensation running down the legs and soreness at the injection site. These side effects are temporary and will resolve in a few hours. We recommend you rest for 1-2 days and gradually return to usual activities.

What risks and complications could occur?

As with any minimally invasive procedure, a few risks are associated with the lumbar sympathetic block. These include allergic reaction to medication or contrast material, infection, bleeding, and low blood pressure.

Who should not have a lumbar sympathetic block?

The lumbar sympathetic block cannot be performed if the patient:

  • Has an active infection
  • Has uncontrolled diabetes or heart condition
  • Is taking blood-thinning medications (Coumadin, Plavix, Pletal)
  • As an allergy to anesthetics, clonidine, and/or adrenaline
  • Has a bleeding disorder
  • Has a high fever

What conditions are treated with the lumbar sympathetic block?

The lumbar sympathetic block is used to treat:

  • Neuropathy (nerve disease)
  • Complex regional pain syndrome (CRPS)
  • Vascular insufficiency
  • Shingles and post-herpetic neuralgia
  • Pain associated with malignancies
  • Chronic pelvic pain

Is the lumbar sympathetic nerve block effective?

In a recent study of patients who were suffering from lumbar spinal stenosis and radiculopathy, the lumbar sympathetic block was found to improve symptoms and physical function. Patients reported that the results lasted 1-2 months following the procedure. Other clinical research reports show a success rate of 80% for this procedure when used to treat CRPS and neuropathy.

Resources

Bottger E, Diehlmann K. Selected interventional methods for the treatment of chronic pain: Part 1: peripheral nerve block and sympathetic block. Deratology Anaesthesist. 2011;60(5):479-491;quiz 492.

Hong JH, Kim AR, Lee MY, Kim YC, Oh MJ. A prospective evaluation of psoas muscle and intravascular injection in lumbar sympathetic ganglion block. Anesthesia and analgesia. 2010;111(3):802-807.

Hong JH, Oh MJ. Comparison of multilevel with single level injection during lumbar sympathetic ganglion block: Efficacy of sympatholysis and incidence of psoas muscle injection. The Korean journal of pain. 2010;23(2):131-136.

Ifuku,M., Iseki, M., Haseqawa, R., Morita, Y. 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.