c4- Lumbar Sympathetic Block

1. What is the lumbar sympathetic nerve, what is its function, where is it located?

 The lumbar sympathetic nerves exit from both sides between the first and fifth lumbar vertebrae and extend downward along the anterior part of the vertebrae. These nerves control the pain sensation and blood flow going to the legs.

 

 

Lumbar Sympathetic Chain Anatomy

2. What is a lumbar sympathetic block, what is its purpose, how does it work?

A lumbar sympathetic block is a procedure where the sympathetic nerves in the lumbar region are numbed with a local anesthetic. In diseases such as reflex sympathetic dystrophy, pain syndromes associated with the sympathetic system, complex regional pain syndrome, and herpes zoster, the sympathetic system is overactive and excessively constricts the vessels in the area. This leads to the patient's symptoms. The goal of the block is to deactivate the overactive sympathetic nerves. By blocking the overactivity, significant improvement in symptoms is achieved.

3. In which diseases is the lumbar sympathetic block applied?

• Complex regional pain syndromes related to the legs
• Neuropathic pains
• Phantom limb pain
• Raynaud's disease
• Postherpetic neuralgia, pain after shingles
• Hyperhidrosis, excessive sweating

4. What preparation is required for the procedure?

 Food and liquid intake should be stopped 4 hours before the procedure. However, you should take any other medications you are using for different diseases with a small amount of water as permitted by your doctor. Inform your doctor about any drug allergies you have during your initial visit. Come to the appointment without jewelry such as necklaces, earrings, watches, rings, or bracelets. You are not allowed to drive due to the effect of the sedation applied during the procedure on mental functions and the effect of the local anesthetic applied to the procedure area causing weakness in the legs. Therefore, you should come with a relative who can accompany you after the procedure.

5. What are the benefits of the procedure?

Generally, pain begins to decrease within 15-20 minutes after the procedure. At the same time, the temperature in the affected leg also begins to increase due to the increased blood flow.

6. How is it applied?

Before the procedure, you are required to sign an informed consent form due to legal obligations. After a vein is accessed in the patient, they are taken to conditions similar to an operating room where pulse, blood pressure, blood oxygen levels, and breathing are monitored. These values are continuously monitored throughout the procedure. The patient lies face down and a pillow may be placed under the abdomen if necessary. Then, after administering sedative drugs through the vein, the area is cleaned with antiseptic solutions and draped. The entry point for the needle is determined in the lumbar region and confirmed with an imaging device. After numbing the entry point with a local anesthetic, the position is confirmed again under the imaging device with a contrast dye, and a mixture of local anesthetic with a steroid is injected to perform the block. Afterwards, the patient is taken to their room and observed for about 2 hours. After the observation period, you are sent home with an accompanying relative.

Lumbar Sympathetic Block

7. What can happen after the procedure, what are the benefits?

After the procedure, numbness, tingling, or weakness may occur in the relevant leg. These side effects usually subside within 4-6 hours. There may be pain at the needle entry point, which usually responds to analgesic treatment. Entering the vessels in the intervention area can lead to bleeding, and entering the intra-abdominal organs can cause damage to these organs. However, all these are extremely rare. If the imaging device is used correctly, they are almost nonexistent. Immediate reduction in pain and other complaints after the procedure indicates its success. After the procedure, due to the improved blood flow, coldness in the leg, sweating, and color change disappear. Pain decreases immediately after the procedure but may increase from the second or third day up to the seventh day. This is due to the injection process itself and can be easily controlled with the pain medication given. At the end of the first week, the treatment starts to settle down, and a significant improvement in pain and other complaints is observed over a period of about 3 weeks.

8. What is the purpose of the lumbar sympathetic block?

The purpose of the block is to block the nerves of the sympathetic nervous system in the lumbar region. Blocking the sympathetic nerves reduces complaints such as pain, swelling, redness, and sweating and improves leg movements.

9. How long does the procedure take?

The procedure takes 15-20 minutes and is performed under operating room conditions. Since the patient is observed afterwards, the total stay at the hospital can be around 3-4 hours.

10. Is the procedure painful, is anesthesia given?

During the procedure, both the needle entry point and the path of the needle are numbed with local anesthesia. Moreover, sedative medications can be given for comfort. Therefore, the patient does not feel any pain during the procedure. After the procedure, there may be slight pain at the injection site, which can be treated with pain medication.

 

11. What should I do after the procedure?

 It is recommended that you rest for 4-5 days after the procedure. You can take care of your needs such as eating, using the toilet, and bathing. Other than that, you should rest continuously in a lying position that does not cause discomfort. Patients who are working are given a medical report excusing them from work.

12. Can I go back to work the day after the procedure?

 Since four to five days of bed rest is necessary, patients who are working are given a medical report.

13. How long does the effect of the procedure last, how many injections are required? Analgesic effectiveness lasting for months can be achieved after repeated blocks. In some patients, treatment is provided with 1-2 injections, while in others, it may not be effective at all.
14. Will the block be beneficial for me?

It cannot be predicted in advance how it will affect each patient. The effectiveness is higher in patients who seek treatment in the early stages, while the success rate is lower in patients who have had symptoms for more than 6 months.

15. Is the procedure risky, what are the risks?

 Risks are minimal when performed by an experienced physician under appropriate conditions. The most common risk is bleeding or infection at the injection site. Accidental puncture of blood vessels or abdominal organs can occur, but with imaging guidance, these risks are significantly reduced. Other rare complications may include allergic reactions to the medications used or more serious complications like a collapsed lung, although this is extremely rare in lumbar procedures compared to those that involve the chest.

16. Who should not receive a Lumbar Sympathetic Block? The procedure is not performed on patients who have allergies to the drugs used during the procedure, those who are taking blood thinners such as Coumadin or Plavix, or patients who have an active infection in the area to be treated or anywhere in the body.