Lumbar Sympathetic Nerve Block

What is it?
A sympathetic nerve block is performed to determine if there is damage to the sympathetic nerve chain and if it is the source of pain.  This is a diagnostic test primarily, but it may provide relief far in excess of the duration of the anesthetic.

How is it done?
The patient may be given IV sedation.  A local skin anesthetic is given in the lumbar area of the back.  A needle is then inserted into the back under fluoroscopy next to the vertebral body at the lumbar-2 or lumbar-3 level.  The block may be performed on both sides of the spine at one or both of these levels.  An anesthetic medication with or without steroid will be injected into the area or areas. 

Expected Results:
The patient may note redness of the lower extremity and a feeling of warmth.   Pain relief should occur if the pain is from a sympathetic source.

How long does it take?
It takes 30 minutes for the procedure followed by approximately 30 to 40 minutes of recovery time.

Glossary:
Sympathetic Nerves - A network of nerves extending the length of the spine that control some of the voluntary functions of the body, such as opening and narrowing of blood vessels.

Preparing for your procedure:
Please complete the pre-procedure pain diagram form and bring this form with you the day of your procedure.  Include a list of any and all medications you are currently taking.

If you have had an MRI, CT scan or other films, please bring copies with you.   The procedure will be canceled if films are not available.

Plan to be at the hospital up to 3 hours.  Please do not bring young children with you.

The day of your procedure:
On the day of your procedure, report directly to the Short Stay Unit on the second floor of the Acute Care Pavilion at least one hour prior to your scheduled appointment time for registration.  Please bring your insurance information with you. 

Wear loose comfortable clothing; please do not wear dresses or skirts. 

You must have a driver accompany you on the day of your procedure.  You may receive light IV sedation for the procedure.  If a driver is unavailable, the procedure will be canceled per hospital policy.   We must be able to contact your driver before, during and after your procedure either by phone or pager (pagers are available at the Short Stay Unit front desk…please ask).

Please do not eat or drink for at least 4 hours prior to the procedure.  A snack will be provided after the procedure.

You may take pain medicine up to 2 hours prior to the exam time with a sip of water.  If you receive pain medication by a skin patch, you must call the nurses at 443-481-1385 for further instructions.  You may bring your pain medication with you to take after the procedure.

If you are DIABETIC:
If your exam is before 12 noon, do not eat or take any diabetic medication before the procedure.  Bring your medication with you.

If your exam is 12 noon or after, please eat breakfast before 7:00 am and take your diabetes pill or ½ your morning dose of insulin.  Bring your medication with you.

Other MEDICATIONS:
Please take all of your routinely prescribed medications the day of the procedure including blood pressure, heart, thyroid pills, etc. 

NOTE: If you take BLOOD THINNERS OR ANTIPLATLET medications (examples: Coumadin, Heparin. Plavix or Lovenox) please contact the prescribing physician to discuss your risk of stopping these medications for your test/procedure.  We REQUIRE that Coumadin is stopped for 5 days prior to your test/procedure, and that Plavix is stopped for 7 days prior to your test/procedure.   Please call 443-481-1385 for further instructions or if you have questions about your medications.    YOUR PROCEDURE WILL BE CANCELED IF THESE MEDICATIONS HAVE NOT BEEN STOPPED. 

You must be healthy the day of the exam.  You cannot have a fever, infection, sore throat or cough. Please call 443-481-1385 Monday through Friday 8 am to 5 pm; leave a message and one of the nurses will call you back to discuss your possible illness.

There you will be seen by Dr. Thompson, Dr. Eckel, Dr. Dagher, or Dr. Clark before the procedure to discuss your condition, x-rays, and purpose of the injection.

After the procedure:
You will be given written discharge instructions before you leave and the procedure will be explained to you and your driver.  The films that you brought with you will be returned upon your discharge.

Your referring physician will receive a dictated report from Dr. Thompson, Dr. Eckel, Dr. Dagher or Dr. Clark 8 to 10 days following your visit.

If you are in physical therapy, check with your referring physician before resuming treatment.  Dr. Thompson, Dr. Eckel, Dr. Dagher and Dr. Clark recommend delaying physical therapy 48 to 72 hours post procedure.

If you have any questions regarding your procedure, please call the nurses at 443-481-1385.