The autonomic nervous system handles a lot of bodily functions and involuntary processes. The autonomic nervous system can be further grouped into the sympathetic and parasympathetic nervous systems: these nerves control involuntary body functions, such as heart rate, blood pressure, digestion, sweating, and others. The trunks of the sympathetic nerves are grouped and found along the ventral (front) side of the spinal column.
A lumbar sympathetic block is typically done for both diagnostic and therapeutic reasons. This allows the Las Vegas pain management doctor to identify the source of persistent pain, and at the same time, relieves conditions that cause excessive stimulation of the sympathetic nerve.
The procedure is indicated for conditions that cause excessive stimulation of the sympathetic nervous system. These include, among others, Complex Regional Pain Syndrome (or Reflex Sympathetic Dystrophy), diseases such as herpes zoster (or shingles), neuropathies, and peripheral vascular disease. Chronic pain has also been shown to respond to sympathetic blocks.
The procedure can be doneon an outpatient basis. (It does not require inpatient admission.) It is a well-tolerated and quick procedure. While the time varies based on the particular circumstances of the case and the experience of the pain management doctor in Las Vegas, it can typically take less than 30 to 45 minutes. The patient is kept under observation in the recovery room for 20 to 30 minutes, and if no untoward symptoms are observed, the physician can send the patient home within the day.
Lumbar sympathetic nerve blocks are carried out under local anesthesia, although a mild sedative can be given to the patient to calm him or her down. The procedure requires a sterile technique, and can be done in procedure room. Prior to the start of the procedure, the procedure site is prepped with an antiseptic solution, such as chlorhexidine or povidone iodine, and the surrounding area is draped with sterile linen.
The procedure begins with the insertion of the needle in the injection site. This is typically done under fluoroscopic (X-ray) guidance, although other guiding modalities have been used in recent years, such as computerized tomography (CT), and ultrasonography to provide guidance of the needle. The needle continues through muscle and tissue until the target area is reached, as confirmed by imaging. A local anesthetic is then injected into the area around the lumbar sympathetic plexus.
If the block is successful, immediate signs of relief from the sympathetic overstimulation will be observed. This can manifest as less reddening, an increase in temperature, or relief of pain. Once success is confirmed, the Las Vegas pain doctor will withdraw the needle, or complete other nerve blocks as necessary.
Lumbar sympathetic blocks are known to have generally good outcomes, and most patients will report a successful resolution of symptoms. Adverse outcomes (pain and bruising at the injection site) are rare. When they arise, these can easily be managed with medications.
Similar to any invasive procedure, there is risk for infection at the surgical site, and intraoperative damage to the surrounding nerves, muscles and tissues.
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