Sympathetic Nerve Blocks
The sympathetic nervous system is the means by which pain signals travel to the brain to be interpreted. The nervous system can become injured or ‘miswired’ to cause ordinary stimuli or pain to be perceived as more intense, different, or persistent. This change in the sympathetic nervous system is the cause of sympathetically mediated pain. Sympathetically mediated pain can occur anywhere in the body where the sympathetic nervous system exists, specifically, the head, arms, abdomen, pelvis, and legs.
During the procedure, the patient is positioned according to the procedure to be performed; Stellate ganglion injection – face up on the table, injection is at the base of the neck on the same side as the pain, lumbar sympathetic ganglion and Hypogastric plexus injections – face down on the procedure table, injection is in the lower back on the same side as the pain, and ganglion Impar injection – face down on the procedure table, injection is in the sacral area at the midline. The area to be injected is cleaned with an antiseptic and draped using sterile technique. Using fluoroscopic (low dose x-ray) guidance, the area of interest is identified and the skin is anesthetized. Using a needle, guided by fluoroscopy and bony landmarks, the appropriate sympathetic chain is identified. A solution of anesthetic and steroid, dependent on technique, is injected. It takes up to 30 minutes for the medication to take effect. The patient is asked to keep a pain journal for the next few days. The patient is reassessed in the following weeks to determine the efficacy of the procedure.