frequent procedures
LUMBAR SYMPATHETIC BLOCK
The lumbar sympathetic block is usually
done for treatment of reflex sympathetic dystrophy of the lower
extremity. The autonomic nervous system consists of the sympathetic
innervation and parasympathetic innervation, both of which act to
provide a balance in any individual patient or function. This is not
considered to be a part of the central nervous system. The
sympathetic nerve block done at the lumbar level is aimed at
interrupting the abnormal firing that occurs in the sympathetic
chain within the autonomic nervous system and feeds into the reflex
sympathetic dystrophy disease in the individual patients. The aim is
to reduce or eliminate pain in these patients. The procedure is
usually done in a series spaced approximately one week apart in
order to affect the activity within the dorsal horn of the spinal
cord and alter the function of the NMDA receptors and achieve pain
control. The lumbar sympathetic block involves careful placement
under fluoroscopic guidance of a needle as well as using local
anesthetic to block any skin pain and the injection is done with
pure local anesthetic like lidocaine 1% after confirming placement
of the needle within the compartment desired by injecting a contrast
material (dye). Following this, injection of local anesthetic is
done if a simple lumbar sympathetic block is desired and this
process is repeated serially in the next five to six weeks.
Sometimes, the procedure can be done and a catheter inserted into
these compartments for a continuous infusion to occur in an effort
to control pain.
TYPES OF SYMPATHETIC NERVE BLOCK:
-
Sympathetic nerve
block can be done serially with a simple local anesthetic.
-
Sympathetic nerve
block can be done with the aid of a catheter placed within the
sympathetic chain with infusion being given to the patient on a
daily basis at home. In very reflex sympathetic dystrophy
situations, this can be a viable option that can significantly
lower the patient’s pain level and allow the patient to function
without significant motor block in the lower extremity. In other
words, the patient will have pain relief and be able to move
around but will have to carry a catheter and be receiving
infusion by a home care nurse in those severe reflex sympathetic
dystrophy situations.
-
The patient may
also receive injection into the area with a neurolytic substance
such as alcohol or phenol (6%). Following each of these
procedures, the patient tends to notice significant improvement
in the cold temperatures usually prevalent in reflex sympathetic
dystrophy in the lower extremity affected. The lower extremity
and the foot becomes warm and pink and marked pain reduction or
complete pain resolution occurs. The patient’s stiffness of
joints may also improve. In addition, the patient is also able
to block the previous sensation of hyperpathia and allodynia,
both of which resulted previously and prior to the sympathetic
block in increased pain with mere touch in severe cases.
CONTRAINDICATIONS:
Patients who are pregnant or suspected to be pregnant should notify
the physician immediately to avoid exposure to x-rays. Active use of
Coumadin or heparin is also a contraindication of this procedure.
Coumadin should be discontinued about three days prior to the
procedure with the permission of the prescribing physician for the
anticoagulants.
COMPLICATIONS: Complications are rare. However, the likely
scenario may include a blood vessel puncture during the procedure,
which is usually benign unless the patient has a dangerous late
stage aneurysm of the abdominal aorta, which could be affected by
this procedure and result in a life-threatening bleed. Infection is
another possibility.
SEDATIVES: Sedatives can be made available to patients who
are anxious or on request. Otherwise, the procedure itself is quick
and benign and sedation and general anesthesia are not necessary.
The patient will get adequate local anesthesia, which usually will
suffice.
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