What is it?
The sympathetic nerves are found along the front side of the spinal column and are part of your autonomic nervous system. This means that they control involuntary body functions such as heart rate, blood pressure, digestion and even sweating. Sometimes this group of nerves cause pain and can lead to a condition known as Chronic Regional Pain Syndrome (CRPS).
A sympathetic nerve block is an injection of a local anesthetic into the area in which these nerves coalesce, called the Sympathetic Ganglion. This blocks these nerves so that the sympathetic nervous system can no longer mediate the pain.
The first injection is done as a test. If you experience pain relief, it confirms that those are the specific nerves causing the pain and more injections will be scheduled.
Preparing for the Procedure
You should not eat or drink for at least six hours before your scheduled procedure. Small sips of water are allowed if you need to take medications.
Although the injection itself will only take a few minutes, you need to allow 1 to 1.5 hours for your appointment. This time includes registration, physician consultation and examination, the procedure and recovery time. You cannot drive yourself home after the procedure; so make arrangements for a friend or family member to stay with you.
Note: If you take any type of blood-thinning or diabetic medication, it’s important that you notify us before your procedure and we will give you instructions about what you need to do.
What Happens During the Procedure?
You will be lying on your back or your stomach on a foam-cushioned form on an X-ray table. During and after the procedure, you will be monitored with EKG, a blood pressure cuff, and a blood oxygen monitoring device. The skin will be cleansed with an antiseptic solution and then the injection is carried out.
The procedure itself only takes 10-15 minutes to perform. You will be observed in the recovery room for 20-60 minutes after the procedure.
What Happens After the Procedure?
Immediately following the procedure, you will go to a recovery room and will be in a reclined position. Prior to going home, your physician will ask you to make some movements to assess if you have had any change in your pain level. You may also be given a pain log to take with you to track your pain level and location for the first 24 hours following your injection. This serves to confirm the diagnosis of CRPS.
Most often you can go home in about 20-60 minutes. Written instructions will be sent home with you. You will need someone to drive you home and care for you for the first few hours after the procedure. It is therefore imperative that you test your level of relief. If you are involved in a course of physical therapy, it is often beneficial to schedule an appointment 1.5-2 hours after your block is scheduled so that your therapist can accomplish more as a result of the pain relief.
What Are the Outcomes of the Procedure?
The major goal of the procedure is pain relief. You may be sore for a day or so afterward. Temporarily interrupting the input of pain signals to the central nervous system by performing a series of blocks may help the nervous system “reset”, resulting in sustained reduction of pain. These injections are typically scheduled for a series of three, separated by 1 week. If the injections confirm the diagnosis but do not result in sustained relief, other treatments for CRPS can be considered.
Sympathetic nerve blocks can be effective in relieving some chronic pain conditions, but not all. When they are performed as a series of injections over several weeks as opposed to a single injection, the outcomes are generally better. If you experience pain relief from a sympathetic nerve block, it also gives you a “window of opportunity” to more fully participate in other therapies that can contribute to your pain relief, such as physical therapy.
The earlier in your pain process you see a physician that routinely treats sympathetically mediated pain, the more likely you are to achieve success. When this type of pain goes on for more than six months untreated, then the chances of success fall dramatically.
What to expect the day of your procedure?
You are expected to arrive at the surgery center at least one hour before your procedure is scheduled. Bring a responsible adult driver with you because you may be receiving medications that could impair your ability to drive. Unless you are certain you will not be receiving sedation, do not eat anything for 6 hours prior to your procedure; you may have modest amounts of clear liquids (liquids you can see through) up to 4 hours beforehand. Please take your regularly scheduled blood pressure, heart, asthma, long-acting narcotic and nerve pain medications with sips of water as you normally would. If you have diabetes, take half of your normal dosage and bring your insulin with you. Be sure to discontinue aspirin products and any other blood thinners as instructed.
After you arrive, you will be asked to sign-in and complete any paperwork as needed. You will then be taken to the preoperative area. At this time, a nurse will ask you some medical questions and have you sign your consent forms. It is imperative that you, the patient, inform the assistant of any changes in your history and/or physical, such as recent flu or any health problems that might affect your procedure. Inform the staff of any allergies, especially to Betadine or Iodine.
You may be asked to change into a gown. An assistant will take your vital signs. An IV may be ordered by your physician in order to provide pain relief and relaxation.
The physician and nurse will talk to you before your procedure. In certain cases, an anesthesiologist may also be utilized. You will then be positioned and the injection sites will be prepped. Your pain management physician will perform the procedure. Medications may be administered before and during your procedure to help you relax and provide pain relief. You may doze off during this time. Afterward, bandages will be applied as needed.
You will be transported to the recovery room area where you will be monitored anywhere from 30 minutes to an hour. You will be offered beverages and some crackers. After this, someone will take out your IV and help you get dressed if needed. Lastly, your caregiver will be given discharge instructions for your care at home.