Sympathetic Nerve Blocks
Cervical, Thoracic and Lumbar
What Are the Sympathetic Nerves?
The sympathetic nerves are a chain of nerves that run on the front side of the spinal column. They are part of the autonomic nervous system, which controls many bodily functions we don’t think about, such as sweating, heart rate, digestion, and blood pressure. They are located in your cervical, thoracic and lumbo-sacral spine. Another function of these nerves related to the transmission of chronic pain signals. On occasion, for reasons not clear, the sympathetic nerves can develop changes in the way they function. It can result in conditions in which the pain is out of proportion to the patient conditions. It is somewhat analogous to a seizure disorder.
What Is a Sympathetic Block?
It is a procedure in which a solution of local anesthetic (numbing medication) and sometimes steroids (potent long lasting anti-inflammatory) is injected in a specific system of nerves called the sympathetic nerves. The purpose of this injection is to treat conditions that are associated with pain, which originates in the sympathetic nerves. It is also use to identify or exclude a specific source of pain, so proper treatment can be instituted.
The procedure can be performed as an outpatient, in the office, hospital and out patient surgical facility. . The procedure is usually performed under intravenous sedation to assist in comfort and relaxation. This decision will be made based on individual preference and medical necessity. Oral medications are also available to assist with relaxation before and during the procedure. You will be taken to the procedure suite, place in the fluoroscopy bed lying on your stomach. Blood pressure, oximetry and cardiac monitors will be applied.
Next, the skin overlying the painful nerves or areas will be cleansed with a sterile solution. Then a solution of local anesthetic (numbing medication) and an anti-inflammatory (steroid) is injected into a specific sympathetic nerve, under fluoroscopic guidance (X-Ray machine). Prior to the injection, a small amount of contrast (X-ray dye) in injected to confirm proper placement. According to the location, specific responses will dictate the effectiveness of the block. I perform in the neck, is called a Stellate Ganglion Block and resultant increase in the same upper extremity temperature is indicative of proper response. If done in the lumbar area, a resultant increase in the leg temperature is indicative of proper blockade.
After the Procedure
You will go back to the post anesthesia care unit (if you received intravenous sedation), where you will be monitored for 30-60 minutes according to your response. If no sedation was used, according to your specific condition, you may proceed to the post procedure observation area. Immediately after the procedure, you will be evaluated to assess for specific response. A post procedure evaluation form to assess the effectiveness of the injections will be given to the patient prior to discharge. Post procedure instructions will be given in a pre-printed form. A follow up appointment will be made for follow up and to determine if a repeat injection may be necessary. Frequently, according to your specific response, more injections may be indicated. It is not advisable that you drive the day of the procedure.
General Pre and Post Procedure Instructions
If no intravenous sedation is planned, you continue with your usual dietary habits the day of the procedure. If intravenous sedation is planned, avoid eating any king of solid foods prior to the procedure and you may have clear liquids up to 4 hours prior to the procedure. If you are taking Coumadin, Heparin, Plavix or non-steroidal anti-inflamatories (such as aspirin, ketoprofen, naproxen or others), stop taking them at least one week prior to the procedure. If you are diabetic and planning on having IV sedation, our office will give you specific instructions. The decision to return to work after the procedure will be made on an individual basis considering medical necessity and your specific condition.