Sympathetic Ganglion Blocks

Cervical, Stellate, Thoracic, Lumbar, and Hypogastric Sympathetic Blocks

What are the sympathetic nerves?

The sympathetic nerves are a chain of nerves that run on the front side 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, the sympathetic nervous system can become activated and transmit pain following an injury, be it minor or major. This can result in a condition known as Chronic Regional Pain Syndrome (CRPS)-formerly known as Reflex Sympathetic Dystrophy (RSD). Symptoms of CRPS include severe burning pain, swelling, and skin color changes.

What is a Sympathetic Block? Why is it helpful?

A sympathetic block involves injecting local anesthetic around the sympathetic nerves in the neck or low back.

The Stellate Ganglion is a grouping of sympathetic nerves in the neck. A Stellate Ganglion Block is useful for arm, shoulder or facial pain. For the pain management of thoracic (mid-section) such as pain following thoracic surgery or rib fracture, and thoracic (mid-section), the sympathetic nerves in the mid-section are targeted.

A hypogastric plexus block is performed for the diagnosis and treatment of pelvic pain. Most pain sensations from your pelvis first pass through a bundle of nerves called a plexus. A hypogastric plexus block is an injection in your back of a local anesthetic (like Novocain ) in the area of a nerve plexus which goes to (innervates) the organs in your pelvis.

For back, leg, or foot pain the sympathetic nerves in the low back are targeted. This is called a Lumbar Sympathetic Block.

The purpose of these injections is to confirm the diagnosis of CRPS and to calm down the sympathetic nerves. Depending on the severity of the condition, a series of injections may be required.

Sympathetic Nerve Block Procedure:

For the procedure, an intravenous (IV) will be started so that initial anesthetic and relaxation (sedation) medication can be given. You will be taken to a procedure room and positioned on an x-ray table. Monitors will be placed on you so we can monitor your heart rate, blood pressure, and blood oxygen level.

After your skin is washed with a sterile scrub, x-ray images of your back will be taken. Small marks may be placed on your skin using a sterile pen. Next the skin is numbed with local anesthetic medication. Your physician will use fluoroscopy (x ray) to assure correct placement of the needle near the sympathetic nerves. A small amount of x-ray dye is then injected to confirm proper spread of medication. A local anesthetic (numbing) medication is then injected.

Post-Procedure and Follow-up:

• You will then be taken to the recovery area and monitored for 30-60 minutes. Discharge instructions will be given to you before you are discharged. You will be asked to keep track of the amount of pain relief, area of pain relief, and duration of pain relief.
• You will require a driver to take you home because sedation is given during the procedure.
• The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.
• If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more that 10. The response to such injections varies from patient to patient. It is very difficult to predict if the injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment.