Sympathetic Nerve Blocks: A Guide for the Patient

I want to help everyone understand what sympathetic nerve blocks are, what's in them, how they are done, and what to expect. This is a guide for the patient on sympathetic nerve blocks. The lumbar and stellate ganglion sympathetic nerve blocks are the two most common blocks given when treating CRPS/RSD.

What Are Sympathetic Nerve Blocks?

Sympathetic nerve blocks are performed by a Pain Management doctor, who is also an anesthesiologist. Medication is injected directly into the sympathetic nerve endings in the back or neck. The nerve blocks should be done with the aid of a fluoroscope, or live x-ray. This allows the doctor to place the block properly.

Depending on the schedule an individual doctor gives sympathetic nerve blocks, it can range from two times a week to one every week or two. A series of blocks will be done if the first is successful. Each block bringing longer lasting pain relief. Sympathetic nerve blocks are only useful in relieving pain that is sympathetically maintained. This means the pain is being generated by they sympathetic nervous system misfiring.

Nerve blocks do not help relieve pain which is sympathetically independent. Over time pain can evolve from maintained to independent. In sympathetically independent pain there is an alteration in the sending and receiving of signals from the nerve endings. There is permanent damage to the structure of nerves and it no longer responds to anesthetics. Determining whether you have SMP or SIP can only be determined by having a sympathetic nerve block performed.

Lumbar Sympathetic Blocks - LSB

Lumbar sympathetic blocks are given for the lower extremities. An IV is started to give medication to relax you. In most cases the doctor puts you to sleep for the short time it takes to do the block. It is a good idea to ask the doctor his policy.

You are placed on your side, a small area of skin is scrubbed and numbed. The doctor then directs a very small needle using the fluoroscope to the nerve bundle. A small amount of dye is used to ensure proper placement. A mixture of local anesthetic such as lidocaine or bupivacaine, saline and anti-inflammatory is injected.

It is important to rest for the first twenty-four hours. There may be some soreness in the area where you received the injection. For several hours your leg will be a normal temperature and color. The leg will be numb and you may have difficulty walking.

Stellate Ganglion Block - SGB

Stellate Ganglion Blocks are given for the upper extremities. An IV will be started to give you medication to relax. You will lay on your back with head tilted. The area is scrubbed and numbed with a local anesthetic. With the aid of the fluoroscope, the same mixture of medications used in the lumbar block is injected beside the windpipe or trachea.

With the stellate ganglion block, you will notice some changes. Your voice may become hoarse because of the numbing medication. The eye on the side of your face where the block was done may droop slightly. This is called a Horner's sign.

You will be encouraged to take small sips of fluids and bites of food following the block. The numbness around the vocal cords may cause you to cough when trying to eat or drink.

Rest for the first twenty-four hours. Your arm will be numb and you won't be able to use it. The skin temperature and color will be normal for a few hours.

This is an overview of what will happen during sympathetic blocks. There may be slight differences in position during a block. When you leave you may be sent directly to physical therapy to have the limb manipulated. This is done in some situations because it is too painful normally. Follow the directions of the doctor for what you need to do before and after having a sympathetic block done. Each situation is unique.