Lumbar Sympathetic Block: Benefits, Side-Effects, Technique, Indications, Contraindications, Complications
Lumbar sympathetic block is considered as a treatment option for chronic pain in back and legs. It is also known as lumbar sympathetic ganglion block and is commonly used to treat back or leg pain and sciatica, in conditions that have not responded to other treatments.
Understanding Lumbar Sympathetic Block
Considering low back pain and nerve related symptoms in chronic sciatic pain, a treatment that directly targets the affected area is essential. Lumbar sympathetic block is a treatment that involves injecting a medicine into the sympathetic nerves, which are carrying pain signals to the spinal cord.
Lumbar sympathetic block or lumbar sympathetic nerve block is a diagnostic as well as treatment modality. As a diagnostic procedure, lumbar sympathetic block helps to identify the pain information being carried by the sympathetic nerves and to plan appropriate treatment measures. As a treatment modality, lumbar sympathetic block helps to reduce pain, swelling and discomfort in the legs.
Low back pain (lumbar pain) and leg pain (sciatica) is common in many joint problems and injuries. In many cases, the pain and discomfort in these areas remain even after various treatment options have been tried. This often results in a chronic pain condition, making it worse.
Lumbar pain may often be associated with radiating pain in legs, burning and tingling sensation along the course of nerves. This can occur as the pain travels through the nerves situated on either side of the spine. There are the sympathetic nerves, which ideally control many bodily functions like digestion, circulation, etc. but sometimes, they can also carry messages of pain to the spinal cord. These nerves are present in a network called ganglions and are targeted in a lumbar sympathetic ganglion block.
Indications for Lumbar Sympathetic Block or Medical Conditions that can be Treated with Lumbar Sympathetic Block
Lumbar sympathetic block can be used in treatment of following medical conditions:
- Reflex Sympathetic Dystrophy (RSD) or Complex Regional Pain Syndrome
- Sympathetic Maintained Pain
- Peripheral Vascular Disease, Vascular insufficiency or Raynaud's Syndrome
- Urogenic pain, pelvic pain or pain due to cancer
- Herpes Zoster or shingles when the legs are involved
- Chronic stomach pain, in some cases
- Peripheral neuropathy
- Diabetic Neuropathy
- Phantom Pain
Contraindications of Lumbar Sympathetic Block
Steroid injection or sympathetic block is contraindicated in persons having any active infection in the body, skin infection, soft tissue abscess or spinal tumor. Lumbar sympathetic ganglion block should be avoided in pregnant ladies and persons having bleeding tendency or bleeding disorders. It is also better avoided in persons taking medications like aspirin or blood thinners and anti-platelet drugs.
Hence, it is important to evaluate the medical history and information about drugs and allergies before considering lumbar sympathetic block for a person. According to the drug history, certain medications may be temporarily stopped for few days, to be able to perform lumbar sympathetic block.
Lumbar Sympathetic Block Technique
The decision of lumbar sympathetic ganglion block is based on severity of the pain. Depending on your pain condition, your physician may decide to use a sympathetic nerve block. When the pain is in the lower back region, affecting the legs, the thick bundle of nerves (ganglion) in the lumbar region is blocked with the injection.
The procedure of lumbar sympathetic block is performed in out-patient setting under local anesthesia. It is given in the form of injection and it helps to numb the area when actually injecting the block. Sometimes, sedation may also be given to ease out anxiety and help in tolerating the procedure well.
Ideally, local anesthetics may be injected in a diagnostic sympathetic block, while other medications or steroids may be injected in a therapeutic sympathetic block. The procedure of lumbar sympathetic block may take around 30 minutes.
Lumbar Sympathetic Block Preparation
A decision of lumbar sympathetic block is made, after clinical examination and thorough evaluation of your condition, medical reports, etc. Any existing condition like high levels of blood sugar, high blood pressure needs to evaluated and a decision is made once the levels are controlled. A detailed history of your medical profile, current / previous medications and history of surgeries, allergies and details of any associated condition may be taken into consideration.
Lumbar sympathetic block procedure is done in fasting, so follow your physician's advice regarding food, medicine and other routine. Details of the procedure, the reasons for doing it and its possible effects are clearly explained to you. Appropriate formalities, informed consent form and documentation is done.
Lumbar Sympathetic Block Procedure
You will be made to lie on the X-Ray surgical table on your stomach, with the back facing upwards. The surgical team will position you in a way that supports the procedure and is comfortable for you. Intravenous line is introduced, so as to facilitate intravenous injections as required. Arrangements for monitoring of blood pressure, oxygen saturation and other parameters are done. You would be monitored and your tolerance would be taken into account during the procedure.
With appropriate aseptic precautions, the skin around the area in the lumbar region to be injected is cleaned and prepared for the lumbar sympathetic block. A local anesthetic agent is injected into the area to be injected with the actual medication.
Further, the procedure is guided by X-Rays, to guide the position of the needle and to confirm the path of the injected medication. A needle is inserted into the defined area in the back, to reach the desired spot in the spine. A dye is then injected and path it travels is confirmed by taking X-rays. Once the course is defined and found as expected, the block medication is injected and the spread is judged with the help of X-rays.
The injecting of medicine takes a few minutes after which, the injected needle is safely removed and a tape is applied on the area.
Lumbar Sympathetic Block Side Effects (Post-Procedure)
After the lumbar sympathetic block procedure, you may be made to rest in the recovery room. Vital signs like blood pressure, pulse rate, temperature, etc. would be checked. Any necessary investigations are done and kept under observation as per the protocol.
There may be pain at the site of injection and the legs may feel warm or numb. This eventually reduces and you can resume normal activities, while avoiding anything rigorous for the first 24 hours.
You can begin with your daily diet and regular activities the following day. Follow your physician's advice about medications, activities and follow-up as suggested.
Warning Signs - Signs you should look for after the lumbar sympathetic block procedure and seek medical advice include-
- Signs of infection or fever lasting for more than 24 hours.
- Numbness and tingling that last for more than 12 to 24 hours needs evaluation to rule out bleeding.
- Increased pain after lumbar sympathetic block procedure may need attention to rule out injury to the nerve.
- Increased levels of blood sugar may be seen in pre-diabetic or diabetic persons and needs to be evaluated.
Complications of Lumbar Sympathetic Block
Generally, lumbar sympathetic block is considered a safe procedure and is not associated with serious consequences. However, infection at the injection site, bleeding, spinal block, epidural block or nerve damage may rarely occur in some cases. Occasionally, response to injected medication or steroids, like flushing, skin irritation, may be noted and needs to be evaluated.
Benefits of Lumbar Sympathetic Block
While the type and rate of improvement in different individuals differ, it is generally seen that when lumbar sympathetic block is timely performed, it helps well. Prediction of the success of lumbar sympathetic block is difficult but most cases respond with decrease in the intensity of pain. The exact performance also depends on the duration, location and cause of the pain or the condition.
Lumbar sympathetic ganglion block, is often given as a series of injections, depending on the cause and the severity of the condition. Based on your response, your physician may suggest the number of injections required.
Usually, single steroid injection (lumbar sympathetic block) may give pain relief for 2 to 6 weeks. A series of few injections or lumbar sympathetic block may provide long term pain relief for about 3 to 6 months.
Taking the right step - Lumbar Sympathetic Block
Lumbar sympathetic block is a well-established procedure that can provide pain relief. If you are suffering from chronic low back pain or leg pain, which does not respond to other treatment, your physician may consider lumbar sympathetic block or lumbar sympathetic ganglion block.