SYMPATHETIC BLOCKS
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.
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. This block is useful for arm, shoulder, or facial pain. 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.
STELLATE GANGLION 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.
CELIAC PLEXUS BLOCK
Blockage of the celiac plexus is indicated to treat visceral pain of malignant (cancer) 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 intestines.
LUMBAR SYMPATHETIC BLOCK
The lumbar sympathetic ganglion is anteriorly to the L2, L3, and L4 vertebral bodies. This block is used for the diagnosis and treatment of lower extremity CRPS. 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 THESE PROCEDURES PERFORMED
All procedures are performed at a certified outpatient surgery center or hospital setting. In most cases we use sedation techniques and use an Anesthesiologist. Patients should have nothing by mouth including water for at least 6 hours prior to the procedure. Regular medications (blood pressure etc.) can be taken with a sip of water. You should not take any pain medications or sedatives prior to the procedure. You will need a ride home and you should not drive yourself for at least 8 hrs after discharge. You may return to normal activities the following day.
WHO SHOULD NOT HAVE THESE PROCEDURES
If you are on blood thinning medications (e.g. Coumadin, Plavix), or if you have an active infection or fever, you should notify the doctor immediately. 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 these procedures.