What is a lumbar sympathetic permanent block?
To the front of the lumbar vertebrae (number 5 in Figure 1) there is a nerve bundle (known as the sympathetic chain or lumbar sympathetic trunk) that is part of a nervous system that we cannot control at will. This separate nervous system controls how much blood flows through the blood vessels, for example. The lumbar sympathetic trunk is also important for pain. Blocking the lumbar sympathetic trunk can relieve pain and sometimes improve blood flow to the legs. The lumbar nerve bundles are located next to the lumbar vertebrae and can be easily reached with a needle. In a lumbar sympathetic permanent block alcohol of phenol is injected through a needle around the lumbar nerve bundles to block this nerve bundles.
Figure 1. Cross-section through the body at the level of the lumbar vertebrae. You are looking at the back from behind and in the middle you can see a vertebra (3). The aorta (1) and vena cava (2) are located to the front of this vertebra. The kidneys (4) are located to the side of the vertebra.
What should I be aware of before undergoing a lumbar sympathetic permanent block?
Any of the following situations should be reported to your pain specialist if he proposes a permanent lumbar sympathetic permanent block:
- If you are pregnant: since X-Ray equipment is used, pregnant women may not undergo a permanent lumbar sympathetic block and a new appointment has to be made.
- If you are ill or have a fever on the day of treatment you cannot undergo a permanent lumbar sympathetic block, in which case a new appointment will have to be made.
- If you are allergic to iodine, bandages, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
- If you are taking blood thinners, you should notify that your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.
How should I prepare for a permanent lumbar sympathetic permanent block?
- No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
- You may eat before treatment and take your normal medication.
- N.B.: this does not include blood thinners, as mentioned above.
- Make sure you have someone to take you home, because you may not drive for 24 hours.
How does a permanent lumbar sympathetic block work?
- The treatment will be performed in the surgical day-care centre, where you will be asked to change into a surgical gown. This gown closes at the back.
- A nurse will escort you to the treatment room, where there is a treatment table, an X-ray machine and television monitors.
- You will be positioned on the treatment table with your stomach on the top of a cushion.
- The blood pressure and the amount of oxygen in your blood will be controlled during the treatment.
- A drip will be placed in your hand.
- The right place of the block is estimated with aid of fluoroscopy.
- This place is marked on the skin with a felt pen.
- The area around this site is then disinfected with a cold, red liquid.
- The pain specialist covers the area with sterile drapes.
- After a local anesthetic has been applied to the skin, the pain specialist, by means of fluoroscopy (via the television monitor), will insert the needles in the correct place.
- Some contrast fluid is also injected to enable the position of the needle to be clearly visible.
- If the needle is in the right place the permanent lumbar sympathetic block is performed.
- In a permanent lumbar sympathetic block, besides local anaesthetics are injected around the lumbar sympathetic nerves, small amount of alcohol or phenol are administrated to permanently block the nerves.
- After this treatment you need to make an appointment at the pain clinic after six to eight weeks with your own pain specialist. The effect of treatment will be checked and further policy will discuss with you.
What are dangers and side effects of a lumbar sympathetic permanent block?
After a permanent lumbar sympathetic block, the following complications or side effects can occur:
- In very rare cases a swelling of the leg can occur because due to the treatment more blood has gone to the leg.
- Temporarily a nerve pain or numbness can occur in the groin and/or upper leg.
- Touching of the skin in this area can be unpleasant and painful.
When can I expect pain relief after the treatment?
- After pains can occur following permanent facet joint nerve blocks. These may last for a week but will eventually disappear.
- The optimum results of treatment are seen after six to eight weeks.
- Around this time, a new appointment with your pain specialist will be made.