Lumbar Sympathetic Block and Radiofrequency Neurotomy
Sympathetic blocks and radiofrequency treatment can be used to treat nerve related pain conditions particularly Complex Regional Pain Syndrome by targeting sympathetically mediated pain.
A lumbar sympathetic block infiltrates local anaesthetic and steroid around the sympathetic nerves. These nerves are located on both sides of the lower spine and control functions such as the regulation of blood flow. The sympathetic block is able to interrupt the pain signals down the leg which is on the same side as the injection with a variable duration of pain relief. Radiofrequency treatment addresses pain by applying targeted heat lesioning of these nerves disrupting pain signals for a period of at least 12 – 24 months.
Lumbar sympathetic block and radiofrequency procedure
Lumbar sympathetic block and radiofrequency are recognised a day case procedure. They are typically performed using fluoroscopy (live X-ray) to help guide the needle accurately and avoid spinal cord or any nerve injury.The procedure will take place in theatre under full aseptic conditions with the patient on his or her stomach. A small needle in the back of your hand can be used to administer sedation or in case of an emergency. The skin is well cleaned before a small amount of local anaesthetic is applied in order to numb the injection area. The physician then directs a needle into the sympathetic nerves injecting a small mixture of steroid (anti-inflammatory medication) and anaesthetic. Lesioning (Radiofrequency neurotomy) of the nerves at a later date will only be indicated if there is a significant reduction in the pain levels.
Patients are then monitored in a recovery area before transfer to the ward and discharge home. Patients may experience a numb feeling for a few hours. Pain at the injection site may increase for seven or more days. It is advisable to rest for 24 hours and resume stretches and exercises when the pain eases. This window of pain relief should be utilised for performance of strengthening exercises and rehabilitation physiotherapy.
There is a variable response to injection treatment. It is important to discuss both the benefits and risks of the procedure with your doctor before any agreement to undergo the procedure is reached. Although the chance of any complications is generally low, as with all surgical procedures, there is an element of risk involved with epidural steroid injection including failure to get benefit or pain aggravation. There may be an allergic reaction to the steroid or any of the medications, or that the injection causes an infection or bleeding. Spinal cord, permanent nerve damage or paralysis is extremely rare.