Lumbar Sympathetic Nerve Block (LSNB)

Orthopaedic & Spine Center

 

Dr. Raj Sureja

Raj N. Sureja, MD

My role as an Interventional Pain Management Physician is to provide treatments that offer pain relief and function restoration without surgery.  A lumbar nerve block delivers a local anesthetic or numbing medication to a nerve or set of nerves near the lower spine to provide pain relief.  The sympathetic nerves are a component of the larger autonomic nervous system, better known as the “fight or flight” nerves.  Although they usually control blood pressure, heart rate and perspiration, sometimes they serve as a conduit for pain after a trauma or illness.

There is a specific group of individuals who may need a LSNB who have not responded well or at all to other treatments, which include patients who have:

  • CRPS (Chronic Regional Pain Syndrome or RSD)
  • Phantom pain from an amputation
  • Diabetic Neuropathy in the legs
  • Post-Herpetic Neuropathy in the legs (from Shingles)
  • Vascular insufficiency in the legs

If you come to me for a consultation for any of these issues, I will do a very thorough physical examination, review years of your medical records and talk with you extensively about what treatments you have had in the past, what worked and what didn’t. 

There are contraindications for LSNB, which are any bleeding issues or infections.  Diabetics, those with glaucoma and those who may be pregnant or are trying to conceive are at higher risk for complications during this procedure.  Contrast dye will be used with x-ray during the procedure, so if you have an allergy, you must mention it. 

If we decide that LSNB is the appropriate treatment for your condition, my procedure scheduler will coordinate a date and time with the surgery center for your appointment. Those who take blood thinners must stop for several days before the procedure, as well as those who take any form of anti-inflammatory, whether it be prescription or OTC, for 10 days before the procedure. Because you will be having twilight sedation, I may have you obtain health clearances from your PCP before your procedure, to ensure it is safe for you to be sedated. You must not eat or drink anything after midnight the day of your scheduled procedure. The only exception may be for high blood pressure or GERD medications taken with a tiny sip of water the morning before your procedure.

The LSNB is done as an outpatient procedure using Monitored Anesthesia Care (MAC), which you may know as conscious sedation or twilight sleep. Sedatives and pain medications will be administered to you through an IV. You will remain awake, peaceful, and able to follow instructions, but will be groggy, and probably won’t remember anything about the procedure. You will be brought into the operating room and asked to lie on your stomach, face down.  Your back will be cleansed with antiseptic and I will numb the area of your injection with local anesthetic.

I will then insert a hollow needle, using x-ray guidance, to the area of the sympathetic nerve cluster or ganglia that corresponds to your described pain.  I will then inject dye and may ask you some questions about what you are feeling, where you are feeling sensation and what it feels like.  Your feedback helps me to know that I am in the precise location for the medication to work the best.  I then inject the medication into the nerve ganglia.  You may feel pressure during the procedure, but it should not be painful.  My staff and I will do everything possible to keep you comfortable.

At that point, the procedure is over and the injection site will be covered with a sterile dressing. You will be taken to a recovery area for 30 minutes to be monitored and to make sure you can walk without weakness in the affected leg.

You will be discharged and must have someone to drive you home.  You should not drive or operate heavy machinery for 24 hours after your procedure.  You should not take a bath or swim for 72 hours after the procedure.  Showering is fine.  If the injection site is sore, you may take Tylenol for pain or ice the site intermittently.

Although this procedure is relatively safe, complications have occurred and include allergic reaction, bleeding, nerve damage, numbness, weakness, low blood pressure, blood in the urine, and paralysis.  Please discuss these with me if you have any concerns.

Lumbar Sympathetic Nerve Blocks can be very effective for patients who do not respond well to other interventions and treatments.  Some patients will require more than one LSNB for optimal results; however, most report that their decrease in pain and return to normal function is well worth the effort.

 

Make an appointment with Dr. Sureja or another OSC provider by clicking the “Request Appointment” button below or by calling (757) 596-1900.

 

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