Sympathetic Nerve Block

What is a Sympathetic Nerve Block?

A Lumbar Sympathetic Nerve Block is an injection of local anesthetic in the “sympathetic nerve tissue” – the nerves which are a part of the Sympathetic Nervous System. The nerves are located on either side of the spine, in the back.

The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, Herpes Zoster (shingles) involving the lower extremity, or back and leg pain for patients who suffer from Sciatica.

A sympathetic nerve block involves injecting a local numbing anesthetic (lidocaine, bupivacaine) and a corticosteroid into the space where the sympathetic nerve ganglion are located. A local skin anesthetic is given first to numb the area and then another needle is inserted near the ganglion. The entire procedure takes less than 15 minutes and X-ray guidance is used to ensure proper needle position. Sometimes your physician will recommend intravenous sedation to make the procedure more comfortable. Your physician will monitor you after the procedure to see what effects the block has on your pain.

What should I do and expect after the procedure?

20-30 minutes after the procedure you will move the affected area to try to provoke your usual pain. You may or may not obtain improvement in the first few hours after the injection depending upon if the sympathetic nerves are carrying your pain signals. You may notice increased warmth in the affected extremity for 4-18 hours after the block. If the sympathetic nerves in the neck are injected (stellate ganglion), you will also notice a slight drooping of the eyelid and redness of the eye for several hours. This is normal, and will resolve over 4-18 hours. You should report your remaining pain (if any) and record the relief you experience during the next week on a “pain diary”€ we will provide. Email or mail the completed pain diary back one week after the injection so that your treating physician can be informed of your results and plan future tests and/or treatment if needed.”

This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risk involves bleeding, infection, spinal block, epidural block, and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.