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Sympathetic Block (Lumbar Sympathetic Block)
A lumbar sympathetic block delivers local anesthetic (and sometimes steroid) directly alongside this nerve chain, interrupting the overactive sympathetic signals and providing relief that can last well beyond the anesthetic's duration.
What is a Sympathetic Block?
The lumbar sympathetic nerves are a chain of nerve fibers running along the front of the lumbar spine that regulate blood flow, sweating, and pain signaling in the lower extremities. When these nerves become overactive — as occurs in Complex Regional Pain Syndrome, vascular insufficiency, and certain other conditions — they can drive intense, burning, and often debilitating leg or foot pain that does not respond to standard pain treatments. A lumbar sympathetic block delivers local anesthetic (and sometimes steroid) directly alongside this nerve chain, interrupting the overactive sympathetic signals and providing relief that can last well beyond the anesthetic's duration. At River Cities Interventional Pain Specialists, this procedure is performed under fluoroscopic guidance for precise, effective placement.
What To Expect
The procedure is performed at Park Plaza Surgical Specialists under fluoroscopic guidance and typically takes 30–45 minutes:
✔️ You'll lie face-down on the procedure table and the skin over the mid-lower back will be cleaned and numbed.
✔️ Using fluoroscopy, Dr. Brewer advances a specialized needle alongside the front of the lumbar vertebrae — the location of the sympathetic nerve chain.
✔️ Contrast dye is used to confirm the medication will spread correctly along the sympathetic chain.
✔️ Local anesthetic with or without additional medication is injected, producing a chemical block of sympathetic nerve activity.
✔️ Warmth and a sense of heaviness in the leg on the treated side are common and expected signs of a successful block.
✔️ You'll be monitored carefully in recovery before returning home.
Results and Recovery
Expect mild soreness at the injection site for 24–48 hours. The leg on the treated side may feel warm, heavy, or temporarily numb for several hours as the anesthetic works. Most patients can return to light activities the following day. For Complex Regional Pain Syndrome, a series of 3–6 blocks is often recommended for cumulative benefit, spaced 1–2 weeks apart. Significant improvement in pain and limb temperature regulation is often noted after a successful series.
WHO IS THIS BEST FOR?
Lumbar sympathetic blocks are most commonly used for patients with:
✔️ Complex Regional Pain Syndrome (CRPS) of the lower extremity
✔️ Peripheral vascular disease causing leg pain at rest
✔️ Raynaud's phenomenon affecting the lower extremities
✔️ Post-herpetic neuralgia in the lower extremity
✔️ Hyperhidrosis (excessive sweating) of the lower limbs
✔️ Phantom limb pain following lower extremity amputation
Frequently Asked Questions
CRPS is a chronic pain condition typically affecting a limb following an injury, surgery, or even a minor event. It causes severe burning pain, skin color and temperature changes, swelling, and hypersensitivity that seems disproportionate to the original injury. Sympathetic nerve blocks are one of the most effective interventional treatments available for CRPS.
Relief from a single block can last days to weeks. With a series of blocks, many CRPS patients experience sustained improvement that outlasts the anesthetic by a significant margin. The cumulative effect of repeated blocks often produces longer-lasting benefit than any single injection.
Because the needle is placed near the aorta and vena cava (the major blood vessels running alongside the lumbar spine), this procedure requires a highly experienced interventional specialist with precise fluoroscopic guidance. Serious complications are rare but possible, which is why we use imaging guidance and take every precaution for patient safety.
Yes. By blocking sympathetic nerve activity, the block can cause dilation of blood vessels in the lower extremity, improving blood flow. This makes it a valuable option for patients with peripheral vascular disease experiencing rest pain or non-healing ulcers in the legs or feet.
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