FAQs on Lumbar Sympathetic Block in Houston

An exciting treatment to relieve a variety of painful conditions impacting lower extremities, lumbar sympathetic block traces its earliest history to 1898. The pain management therapy picked up in the 1980s after New Zealand anesthesiologist Robert Boas used fluoroscopic guidance to prevent any risk of complications or spinal injury.

What is Lumbar Sympathetic Block?

A lumbar sympathetic block procedure relieves pain symptoms on semi-permanent basis by interrupting sympathetic nervous system around the lumbar spine. Sympathetic nerves on both sides of the lower spine are responsible for communication between the spinal cord and peripheral tissues along the lower extremities. In that capacity, these lumbar sympathetic nerves also carry pain information originating from limbs, cancerous tumor, pelvic area, infections, inflammations, or injuries to the spine that transmits the pain further to brain receptors.

The lumbar sympathetic chain comprises of an assortment of nerve fibers running along the front and side of the lumbar vertebrae. A part of the autonomic nervous system, that regulates all involuntary actions, such as heart function, respiration, blood flow, gastrointestinal movement, etc., in the human body, a lumbar sympathetic nerve may become hyperactive due to injuries, post-operative problems, and disorders. Blood vessels in the leg feel the pinch and become constricted. Poor circulation of blood results in pain and swelling.

Lumbar sympathetic block is achieved by injecting numbing medication to these nerves. The disruption in the sympathetic pain transmission “breaks the cycle” of chronic pain symptoms and shield the pain signal from going into the spine. As result, the pain is suppressed.

When Patients Require Lumbar Sympathetic Block? What Conditions Are Treated Through Lumbar Sympathetic Block?

The procedure can be beneficial for patients with following conditions.

  • Reflex sympathetic dystrophy that makes lower extremities subject to pain and swelling. Patients may also feel blood flow constrictions due to vasomotor dysfunction.
  • Phantom limb pain
  • Peripheral neuropathy
  • Arterial problem causing pain in the lower extremities
  • Complex regional pain syndrome leading to burning, atypical pain in lower extremities
  • Leg pain due to herpes zoster infection
  • Pain caused by vascular problem
  • Raynaud’s syndrome or vasospasm that constricts blood supply to lower extremities
  • Cancer pain
  • Pelvic pain
  • Ischemic pain
  • Postherpetic neuralgia
  • Crush injury impacting lower extremities
  • Hyperhidrosis
  • Frostbite
  • Circulatory problems due to vasospastic disease in lower extremities
  • Peripheral vascular problem

How Is Lumbar Sympathetic Block Performed?

The entire lumbar sympathetic block pain management procedure involves three steps:

  • A needle is inserted
  • Dye is injected to confirm the needle position and no threat to blood vessels
  • Numbing/ steroid medication is injected through the needle

Patients lie down in prone position and intravenous sedations are used to make them feel relax. Local anesthetic is used to numb the skin and soft tissues in the injection area before the needle is inserted. Doctors use fluoroscopy machines to ensure that the needle is placed perfectly at the lumbar sympathetic chain. To make it sure that there is no rupture of blood vessels, a dye is put through the needle.

The next stage involves insertion of numbing or steroid medication into the nerve chain. Phenol, a neurolytic agent, is also injected to prolong the effect of the pain medication.

How Long Does It Take?

The entire lumbar sympathetic block procedure takes about 20 to 30 minutes.

Do I Need Rest After Lumbar Sympathetic Block?

Patients are discharged soon after the outpatient procedure unless there is anything abnormal in their vital signs. It is suggested that they took rest for the day and join regular activities that they can tolerate. Avoid stretching or putting stress on the injection site.

How Many Lumbar Sympathetic Block Injections Should I Have?

The number of repeat lumbar sympathetic block injections one requires varies from patient to patient. Many with acute painful conditions may need a series of blocks over an extended period. While two to four injections suffice for many over a year, some may be advised to have around 10 each with a few months gap.

What Are The Side Effects of Lumbar Sympathetic Block?

  • No major side effects associated with lumbar sympathetic block.
  • Patients experience increased temperature over the leg area following the procedure. However, the impact means your block procedure is a success.
  • Once the numbing medication wears off, patients may feel injection-site pain, soreness, and muscle weakness. But it is only a temporary phenomenon and subsides in a few days.
  • There may be risk of bleeding or infection or nerve damage if the appropriate procedure is not followed.

How Well Does Lumbar Sympathetic Block Work? What Are The Benefits of Lumbar Sympathetic Block?

  • Lumbar sympathetic block relieves pain up to over a year based on patient condition without invasive surgery.
  • In 2008, the Anesthesia & Analgesia journal reported a study that found the block an effective way to suppress pain linked to reflex sympathetic dystrophy or complex regional pain syndrome.
  • According to the Clinical Journal of Pain, the procedure is highly beneficial for treating phantom limb pain. (Stanton-Hicks et al 1998)
  • In 2000, the journal Pain Physician reported findings that suggested efficacy of these injections in inhibiting cancer pain in lower extremities and pelvic area.
  • Researchers have also discovered the benefits of lumbar sympathetic block for ischemic limb pain (AmericanJournal of Surgery, 1985) and postherpetic neuralgia (Japanese Clinical Medicine, 2001).
  • A 2012 Cleveland Clinic study listed a number of advantages of the procedure, including constant and considerable pain reduction for more than two years, for peripheral neuropathy patients.

References

Manjunath PS, Jayalakshmi TS, Dureja GP, Prevost AT. Management of lower limb complex regional pain syndrome type 1: An evaluation of percutaneous radiofrequency thermal lumbar sympathectomy versus phenol lumbar sympathetic neurolysis — a pilot study. Anesth Analg. 2008;106(2):647-649.

Stanton-Hicks M, Baron R, Boas R, et al.: Complex regional pain syndromes. guidelines for therapy Clin J Pain. 1998; 14:155-166.

Hashizume K: Herpes zoster and postherpetic neuralgia. Jap J Clin Med. 2001; 59:1738-1742.

Cross F, Cotton L: Chemical lumbar sympathectomy for ischemic rest pain. A randomized, prospective controlled clinical trial. Am J Surg. 1985; 150:341-345.

Elias M: Cervical sympathetic and stellate ganglion blocks. Pain Physician. 2000; 3:294-304.

Cross F, Cotton L: Chemical lumbar sympathectomy for ischemic rest pain. A randomized, prospective controlled clinical trial. Am J Surg. 1985; 150:341-345.

Hashizume K: Herpes zoster and postherpetic neuralgia. Jap J Clin Med. 2001; 59:1738-1742.

Cheng J, Daftari A, Zhou L. Sympathetic blocks provided sustained pain relief in a patient with refractory painful diabetic neuropathy. Case reports in Anesthesiology. 2012;