Pain Management Procedures
Lumbar Sympathetic Block
Lumbar Sympathetic Block
What is it?
The lumbar sympathetic chain is part of the automatic nervous system that affects blood flow, sweating, temperature, and pain signaling in the legs. A lumbar sympathetic block places local anesthetic beside this chain in the lower back. It can help determine whether pain is “sympathetically maintained” and may temporarily reduce it.
When may it be recommended?
The most common pain indication is CRPS affecting a lower limb, especially when pain, color or temperature change, swelling, and touch sensitivity limit rehabilitation. It may also be considered for selected ischemic, phantom-limb, or neuropathic pain conditions. Response varies, and a block is usually one part of a plan that emphasizes movement and functional restoration.
What happens?
You lie face down. Fluoroscopy or CT guides a long needle to the front-side of a lumbar vertebral body, near the sympathetic chain and major blood vessels. Contrast dye confirms spread before local anesthetic is injected. Temperature or blood-flow changes in the leg may be monitored.
What should I expect?
The leg may feel warm, numb, or temporarily weak. Blood pressure can fall, causing lightheadedness. A driver is generally needed. When the block reduces pain, therapy is often scheduled while movement is easier.
Important risks
Risks include bleeding, infection, low blood pressure, medication reaction, nerve injury, kidney or ureter injury, and injection into a blood vessel, spinal canal, or nearby organ. New major weakness, severe abdominal or back pain, fainting, or difficulty breathing requires urgent care.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.