Lumbar sympathetic blocks are a minimally invasive outpatient treatment option that relieves chronic leg and foot pain by injecting steroids into the sympathetic nerves located on the front side of the spine. These blocks can function as a diagnostic tool for chronic lumbar pain. 

Conditions treated

Lumbar sympathetic blocks reduce chronic pain caused by

• Complex regional pain syndrome
• Reflex sympathetic dystrophy
• Vascular insufficiency
• Shingles 
• Neuropathy 
• Phantom limb pain
• Lower limb painful ischemia 
• Cancer pain 
• Raynaud’s syndrome
• Excessive sweating
• Spasms in blood vessels

Benefits

• Pain relief
• Assists in diagnosis process
• Short recovery period
• Non-surgical option for pain relief 

Procedure

Before your procedure, your doctor may ask you to stop taking non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressant medication, and blood thinners to reduce your risk of serious complications or infections. If you are pregnant or suspect you are pregnant, talk to your doctor about alternative treatment options. Your healthcare professional may ask you not to eat or drink several hours before the procedure. This procedure cannot be performed if the patient has an active infection or symptoms of a cold, flu, or similar malady. If you experience these symptoms on the day of the procedure, you will need to reschedule your nerve block. 

Your healthcare professional will ask you to lie face down on an x-ray table and administer a low-grade sedative to help you relax. They will then sanitize your back before injecting a local anesthetic into the lumbar sympathetic ganglia located at the back of the spine. Using x-ray guidance and contrast dye, your healthcare professional will inject the medicine into the proper location. If the lumbar sympathetic block is for therapeutic purposes, they will inject a corticosteroid. Diagnostic lumbar sympathetic blocks use a numbing medication or local anesthetic.

The procedure typically lasts less than thirty minutes. Once the medical practitioner completes the injection, you will remain in an observation room for about fifteen to thirty minutes to ensure no complications or immediate reactions occur. You must be able to walk without feeling weakness in your legs before you can return home. For most patients, this will happen in under an hour. 

Recovery

Once discharged, you will be unable to drive or perform any rigorous activity for the remainder of the day. You will need someone else to drive you home from your procedure. You cannot take a bath or soak in water for three days after the injection. Your healthcare professional will recommend relaxing for the remainder of the day before returning to your normal activities.

You may experience an increase in lower back pain at the injection site, but this pain should dissipate within 48-72 hours. If the pain becomes intolerable, you can take over-the-counter pain medicine or apply an ice compress.

The onset of pain relief and its duration vary greatly among patients. Some patients report feeling immediate pain relief, while others feel relief after several days. Lumbar sympathetic blocks used for diagnostic reasons should provide pain relief within the same day, while therapeutic ones may take up to ten days to provide pain relief. Your pain relief may last several weeks or several months. If these nerve blocks successfully relieve your back pain, your healthcare professional may suggest adding periodic lumbar sympathetic blocks to your routine treatment regimen. 

Risk

Lumbar sympathetic blocks are generally safe procedures, but there remains the possibility for compilations, such as:

• Infection, bleeding, or bruising at the injection site
• Allergic reaction to steroids or anesthesia 
• Nerve damage
• Paralysis 
• Sharp blood pressure decrease
• Anesthetic toxicity 
• Blood in your urine
• Muscular numbness or weakness