Sympathetic Blocks

Sympathetic Blocks

What are the sympathetic nerves?

The sympathetic nerves are a chain of nerves that run along the front of the spinal column. they are part of the autonomic nervous system which controls many bodily functions we don’t think about, such as sweating, heart rate, digestion, and blood pressure. for unknown reasons, this nervous system can become activated and transmit pain following an injury. it might be caused by a minor or a major injury. this can result in a condition known as chronic regional pain syndrome (crps), also known by the term reflex sympathetic dystrophy (rsd). symptoms of crps include severe burning pain, guarding (protecting the extremity), swelling, temperature changes, and skin color changes.

What are sympathetic blocks and why are they helpful?

A sympathetic block involves injection of a local anesthetic and occasionally a steroid around the sympathetic nerves in the neck or back. the stellate ganglion is a group of sympathetic nerves in the neck. when this ganglion is blocked; arm, shoulder, and facial pain is reduced. for abdominal pains or pain caused by cancer, a celiac plexus block is performed. for the lower extremities and back pain, a lumbar sympathetic block is helpful. the purposes of these blocks are both for confirming the diagnosis of crps and temporarily blocking the sympathetic chain. this would be similar to rebooting a computer. depending on the severity of the condition, a series of injections may be required.

What is a stellate gangion block?

The stellate ganglion is formed by the fusion of the inferior cervical and the first thoracic ganglion as they meet anterior to the vertebral body of c7 located in the neck. injection of an anesthetic near the ganglion; blocks the nerves which in turn reduce pain, swelling, color, and sweating changes in the upper extremities and may improve mobility. typical indications include: reflex sympathetic dystrophy, refractory angina, herpes zoster, phantom limb pain, reynaud’s syndrome, and scleroderma.

What is a celiac plexus block?

Blockage of the celiac plexus is indicated to treat visceral pain of malignant origin. it is useful for pain caused by pancreatic cancer. the innervations of the majority of abdominal organs flow through the celiac plexus. this includes the pancreas, liver, gallbladder, omentum, stomach, and small intestine.

What is a lumbar sympathetic block?

The lumbar sympathetic ganglion lies anteriorly to the l2,l3, and l4 vertebral bodies. this block is used for the diagnosis and treatment of lower extremity reflex sympathetic dystrophy. relief of symptoms can far outlast the duration of the local anesthetic injected. the approach for this block is in the back at the l2 vertebra.

How are the procedures performed?

sympathetic blocks are performed by dr. jagodowicz in an operating room setting. an iv will be started so that relaxation medication can be given during the procedure. you will either be on your back or your stomach on a x-ray table. all precautions will be taken to ensure a sterile environment during the procedure. a local anesthetic will be used to numb the skin over the area. dr. jagodowicz will then direct a special spinal needle, using x-ray guidance, into the designated area. when proper placement has been confirmed by fluoroscopy (x-ray) using a contrast dye, a local anesthetic and possiblely a steroid will be injected into the space.

Is the procedure painful?

you may feel some pressure sensation as the space is entered. you will receive sedation (usually by an anesthesiologist) during the procedure and discomfort will be kept to a minimum. post procedure, you may experience some injection site tenderness for several days. cool compresses for 15 minute intervals on and off will usually control the discomfort for the first day.

Is there any risk or side effects from the procedure?

Any time there is an injection through the skin, there is a risk of infection. this is why sterile conditions are used for this procedure. although rare, nerve injury or bleeding may occur.

Who should not have this procedure?

If you are on blood thinning medication (e.g. coumadin, plavix), or if you have an active infection or fever, you should not have the procedure. the procedure can be performed after a period of time when either blood thinning medication has been stopped, or when no active infection or fever is present. if you are pregnant, you should not have this procedure.

What are my pre/post procedure instructions?

Patients should have nothing by mouth for at least 6 hrs. prior to the procedure. you may take your regular medication (blood pressure) with a sip of water. you will need a ride home and you should not drive yourself for at least 8 hrs after the block. you can return to normal activities the following day.