Lumbar Sympathetic Block and Pulsed Rhizotomy
What is a lumbar sympathetic block?A lumbar sympathetic block is an injection of local anaesthetic in the sympathetic nerves at the level of your lumbar spine. They are located on the left and right side of your spine. These nerves control involuntary functions such as the regulation of blood flow in the legs. They can also be associated with maintaining pain signals in certain conditions.
When is a lumbar sympathetic block performed?A lumbar sympathetic block is performed on the same side as the condition (ie left sided block for left leg CRPS). Common conditions where a lumbar sympathetic block is performed include: - Complex regional pain syndrome type I and II - Sympathetically maintained pain - Peripheral vascular disease - Herpes zoster Before the procedureYou will need to fast before the procedure. This means: - No food 6 hours before - No liquids (except water) 6 hours before. This includes coffee, tea, orange juice etc.- You can drink water up to 2 hours before the procedure.
Take your usual medications with a small sip of water.Please contact us if you are taking any blood thinning medications, diabetes medication, pregnant, or unwell. The procedureThe procedure itself takes 15-30 minutes. It is a day case, meaning no overnight stay is required. An Anaesthetist will provide sedation and monitor you during the procedure. The procedure is performed in the operating room with fluoroscopy (X-ray) to ensure accurate needle placement. Specialized equipment including the radiofrequency needle, probe and radiofrequency machine is used to heat the needle to a temperature of 42 degrees. The nerve is pulsed with radiofrequency waves and local anaesthetic with steroid is injected following the nerve ablation. The local anaesthetic provides immediate pain relief, whereas the pulsed radiofrequency and steroid may take several weeks to provide sustained pain relief. Pain relief usually lasts between 6-12 months. The procedure can be repeated if your pain returns.
After the procedureYou will be taken to recovery and monitored until you are ready for discharge. You will not be able to drive, so ensure someone can drive you home safely. Avoid over-exerting yourself immediately after the procedure. You may gradually return to your day-to-day activities. If you develop any symptoms (fever, swelling, worsening weakness or numbness, bleeding, loss of bowel or bladder control) after the procedure or have any other concerns, please contact us, your GP, or your local Emergency Department.
You will be reviewed by our pain nurse via telephone a few days after the procedure.
What are the risks? No procedure is risk-free but the risks for this procedure are considered to be relatively low. Possible risks include infection, bruising, haematoma, nerve injury and allergic reactions. Infection is minimized with appropriate sterile and aseptic precautions. Bleeding risk is minimized by stopping blood-thinning medications a few days prior. If this applies to you, our pain nurse will remind you to stop your blood-thinning medications a few days prior to your procedure. Risk of nerve injury is minimized as we use fluoroscopy to guide accurate needle placement. Severe allergic reactions to the injectates (ie local anaesthetic, steroids) are very uncommon. Steroids may produce side effects including stomach irritation, insomnia, mood swings, flushing, palpitations. Neurological complications including weakness, paraesthesia, numbness have been described but are extremely rare.
Patients need to be aware that the outcome of the procedure is variable between individuals and they may not receive the desired benefits. The therapeutic benefits of the procedure are transient, and repeat injections may be required.
When is a lumbar sympathetic block performed?A lumbar sympathetic block is performed on the same side as the condition (ie left sided block for left leg CRPS). Common conditions where a lumbar sympathetic block is performed include: - Complex regional pain syndrome type I and II - Sympathetically maintained pain - Peripheral vascular disease - Herpes zoster Before the procedureYou will need to fast before the procedure. This means: - No food 6 hours before - No liquids (except water) 6 hours before. This includes coffee, tea, orange juice etc.- You can drink water up to 2 hours before the procedure.
Take your usual medications with a small sip of water.Please contact us if you are taking any blood thinning medications, diabetes medication, pregnant, or unwell. The procedureThe procedure itself takes 15-30 minutes. It is a day case, meaning no overnight stay is required. An Anaesthetist will provide sedation and monitor you during the procedure. The procedure is performed in the operating room with fluoroscopy (X-ray) to ensure accurate needle placement. Specialized equipment including the radiofrequency needle, probe and radiofrequency machine is used to heat the needle to a temperature of 42 degrees. The nerve is pulsed with radiofrequency waves and local anaesthetic with steroid is injected following the nerve ablation. The local anaesthetic provides immediate pain relief, whereas the pulsed radiofrequency and steroid may take several weeks to provide sustained pain relief. Pain relief usually lasts between 6-12 months. The procedure can be repeated if your pain returns.
After the procedureYou will be taken to recovery and monitored until you are ready for discharge. You will not be able to drive, so ensure someone can drive you home safely. Avoid over-exerting yourself immediately after the procedure. You may gradually return to your day-to-day activities. If you develop any symptoms (fever, swelling, worsening weakness or numbness, bleeding, loss of bowel or bladder control) after the procedure or have any other concerns, please contact us, your GP, or your local Emergency Department.
You will be reviewed by our pain nurse via telephone a few days after the procedure.
What are the risks? No procedure is risk-free but the risks for this procedure are considered to be relatively low. Possible risks include infection, bruising, haematoma, nerve injury and allergic reactions. Infection is minimized with appropriate sterile and aseptic precautions. Bleeding risk is minimized by stopping blood-thinning medications a few days prior. If this applies to you, our pain nurse will remind you to stop your blood-thinning medications a few days prior to your procedure. Risk of nerve injury is minimized as we use fluoroscopy to guide accurate needle placement. Severe allergic reactions to the injectates (ie local anaesthetic, steroids) are very uncommon. Steroids may produce side effects including stomach irritation, insomnia, mood swings, flushing, palpitations. Neurological complications including weakness, paraesthesia, numbness have been described but are extremely rare.
Patients need to be aware that the outcome of the procedure is variable between individuals and they may not receive the desired benefits. The therapeutic benefits of the procedure are transient, and repeat injections may be required.
DisclaimerThe above information is for general education only and is not intended as a substitute for your own independant health advice. At Western Pain clinic we comprehensively assess each patients pain condition and provide advice using the latest evidence-based treatments. If you would like to find out more information about lumbar sympathetic blocks, please discuss this with our doctor during your consultation.