Sympathetic Nerve Block Procedure
The sympathetic nervous system is a collection of nerves that control multiple functions throughout the body. It originates from the spinal cord and generally helps control temperature, blood flow and sensitivity. In addition, branches of those nerves combined with other nerves form the spinal cord that play a role in pain perception and transmission (sympathetically mediated pain). The most classic entity associated with the sympathetic nervous system is the pain from RSD (reflex sympathetic dystrophy). The most current state is known as complex regional pain syndrome. The pain is usually described as a burning in quality and usually involving the distal portions of the extremities (arms, hands, legs, knees, ankles or feet). However other pain descriptions such as deep, aching, throbbing or stabbing pain are common. Pain with light touch or pain with exposure to cool temperatures that are usually not painful may occur.
Autonomic changes, such as changes in skin color, temperature, or sweating are frequently seen. Muscle disorders such as tremors, weakness and decreased coordination can develop if the disease becomes progressive. The symptoms may spread beyond the region of initial discomfort.
RSD/CRPS and sympathetic pain may occur following a traumatic injury, most commonly following ankle, knee and wrist injuries. The initial event may be mild to a severe trauma. It is thought that the initiating trauma may also be so slight it may go unnoticed and initiate the onset of the syndrome.
A sympathetic block may be used to help diagnosis the entity, improve the symptoms or even stop the over activity of the sympathetic system.
The sympathetic block is completed under x-ray guidance. The skin is anesthetized for the lumbar sympathetic block. The needle is advanced through the back to the anatomical location of the sympathetic chain at the L2-L3 vertebral level.
Multiple views of the needle placement under fluoroscopy are obtained. After confirmation with contrast dye, a local anesthetic is applied through the needle. Following the procedure, the patient is taken to the recovery room and observed briefly. They are then discharged home the same day.
For upper extremity blocks a very small needle is advanced to the area on the neck, where the sympathetic nerves are located. Confirmation is obtained with fluoroscopy and contrast dye. A local anesthetic solution is injected through the needle to the target area. The patient is taken to the recovery room for a short course of observation and discharged home the same day.
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