The lumbar sympathetic nerves extend from the first to the fifth lumbar vertebrae. These nerves run down either side of the spinal column and control sympathetically mediated pain of the lower extremities, urinary system and genitals.

A lumbar sympathetic block may be used for control of lower extremity pain caused by diabetic neuropathy, nerve injury/damage, reflex sympathetic dystrophy (RSD), phantom limb pain, and postherpetic neuralgia of lumbar and sacral origin. This block can also be used to decrease claudication pain from poor circulation in the legs. A lumbar sympathetic block dilates blood vessels of the lower extremities to improve blood flow and oxygenation to the nerves. When local anesthetic is mixed with long-acting steroids, pain and inflammation are reduced.

Prior to the procedure an intravenous line (IV) will be started and you will be placed on a monitor that will check your blood pressure and heart rate. You will be asked to lie on your stomach supported by pillows. A nurse will give you some sedating medication through your IV and will monitor you throughout the procedure. You will not be totally asleep for the procedure. You should experience reduced anxiety and pain with partial or total amnesia.

A radiology technologist will use an X-ray machine to locate the exact areas targeted for the procedure. Your back will be cleaned with a special solution and draped with sterile drapes. You will feel a burning sensation for 10-15 seconds as the doctor numbs the areas with local anesthetic. You will then feel a pressure sensation and moderate discomfort as the doctor inserts each needle into the correct location. Once the needles are in the correct position, the doctor will inject a mixture of local anesthetic. The medication is injected near nerves providing loss of sensation to the area of pain.

Once the procedure is over, you will be taken to the recovery room and asked to lie down for 30 minutes before preparing to go home.

• The procedure may not help your pain.
• Small risk that your pain will become worse or result in residual pain.
• You may experience bruising at the injection sites.
• You may experience backache or muscle spasm for 24-48 hours following the block.
• The lumbar sympathetic nerves lie close to the large blood vessels in the abdomen. There is a small risk of puncturing one of these blood vessels and causing bleeding, which might require surgery to repair.
• The lumbar sympathetic nerves also lie close to the bowel, and there is a small risk of perforating bowel which might cause an abdominal infection and require surgery to repair.
• In rare instances, damage to spinal nerves or the spinal cord resulting in paralysis or partial muscle weakness or persistent numbness.
• Rarely, reactions to the anesthetic drugs can cause flushing, ringing in your ears, or in very rare instances, seizures or respiratory depression.
• Allergic reactions to medications may cause your heart and breathing to stop or cause death.

• You may feel increased warmth of the lower extremity.
• You may feel some temporary numbness or tingling of the lower extremity.
• It is not uncommon to see a drop in blood pressure after this block.
• You may experience some backache or muscle spasms for the first 24-48 hours.
• Men may experience temporary impotence or failure of ejaculation for 12-24 hours.
• If after a few hours of leaving the Center, any of these symptoms continue to worsen, please call The Pain Treatment Center or the on-call doctor.

It is not possible to predict to what extent, if any, lumbar sympathetic block will relieve your pain. However, this block is known to produce dramatic relief in some patients suffering from sympathetically mediated pain. In many individuals, pain will return gradually. When this occurs, the block may be repeated, or radiofrequency lesioning of the nerve may be considered.

To be most effective, lumbar sympathetic block should be combined with programmed exercises. Your pain doctor can discuss types of exercises with you. Your doctor may also recommend that you schedule an appointment with our Behavioral Medicine doctors to discuss stress management techniques. You may also be asked to stop smoking.