Epidural Sympathetic Nerve Block

An epidural sympathetic nerve block is a procedure used to block or decrease pain in the legs. The sympathetic nerves are located on either side of the spine and control the involuntary functions of the body, such as temperature regulation to the arms and legs, sweating, heart rate, blood pressure and digestion. After an injury or illness, the sympathetic nervous system may not function properly, causing pain. Some of the more common conditions treated include Complex Regional Pain Syndrome (CRPS) and Herpes Zoster (Shingles).

You must have nothing to eat or drink for four hours before the procedure and driving is not allowed for three hours after the procedure due to the side effects of the medications.

When you arrive, a nurse will get a description of your pain and how you are managing daily activities. Your blood pressure, pulse, temperature and weight will be taken. Medications, allergies and a brief health history will be reviewed. It is important to let the nurse know if you have allergies to X-ray dye, Betadine or latex, if you are taking blood thinners, such as Coumadin, Plavix, Pradaxa or Lovenox, if you have diabetes or if you might be pregnant.

An IV lock may also be started in your arm. Temperature strips will be applied to the tops of your feet as this can be a helpful indicator of a successful block.

After discussing treatment with your physician and signing consent forms, you will go the X-ray room where you will be helped onto the X-ray table into the best position for visualizing your spine. We will try to make you as comfortable as possible. Your skin will be cleaned with antiseptic and after numbing the skin on your back, the physician will place a needle into the epidural space using X-ray guidance. A small amount of contrast dye may be injected to confirm the proper placement of the needle and a steroid mixture will be injected. The entire procedure will take less than a few minutes.

The anesthetic can make your legs feel weak or numb so you should plan to stay for about one hour after your procedure while we monitor you. A nurse will be available to answer any questions you might have and review instructions and follow-up care.

When you go home

• Activities: You can resume activities but avoid those that might make your pain worse. You can usually return to work the next day and begin exercising on the second day
• Pain: Ice on the injection site and taking your pain medications will help with any discomfort. Some patients might feel more pain after the injection because the steroid can be irritating to the nerves. You should notice an improvement in three to seven days
• Follow-up: This procedure may be repeated weekly as prescribed by your physician

Many patients will have pain relief after the first or second injection. If you experience little or no pain relief after the second injection, don’t be discouraged! Talk with your physician.