Nerve Blocks

EvergreenHealth can provide a number of procedures to assist with pain management.

Sympathetic / Stellate Ganglion Block

What are the sympathetic nerves and why are sympathetic blocks helpful?

The sympathetic nerves run on the front surface of the spinal column and not in the spinal canal with the nerves that provide sensation and strength to your legs.

The sympathetic nerves are part of the autonomic nervous system, which basically controls functions such as blood flow and temperature regulation to the arms and legs, sweating, heart rate, digestion, and blood pressure.

The autonomic nervous system is responsible for controlling bodily functions that you do not think about or have direct control over.

However, there is a connection between the central nervous system (that you have control over) and the autonomic nervous system. Regulation of this connection can become altered, usually secondary to an injury.

When regulation of the sympathetic nervous system is altered, various pain states can occur including “complex regional pain syndrome”, also known as Reflex Sympathetic Dystrophy (RSD).

What is a sympathetic block and why is it helpful?

A sympathetic nerve block involves injecting numbing medicine around the sympathetic nerves in the low back or neck.

By doing this, the sympathetic nervous system in that area is temporarily ‘switched off’ in hopes of reducing or eliminating pain.

If pain is substantially improved after the block, then a diagnosis of sympathetically mediated pain is established.

The therapeutic effects of the anesthetic can occur, at times, longer than would be normally expected.

The goal is to reset the sympathetic tone to a normal state of regulation. If the initial block is successful, then additional blocks may be repeated if the pain continues to sequentially diminish.

What will happen to me during the procedure?

An IV will be started for safety, and so relaxation medicine can be given if needed.

After lying on an x-ray table, the skin over the area to be injected will be well cleansed.

Next, the physician will numb a small area of skin with numbing medicine (anesthetic) which stings briefly.

The physician will use x-ray guidance to direct a needle to the sympathetic plexus of nerves.

The physician will then inject contrast dye to confirm that the medicine only goes over the targeted sympathetic nerves. Once this occurs, numbing medicine (anesthetic) will then be slowly injected.

What should I do and expect after the procedure?

20-30 minutes after the procedure you will move the affected area to try to provoke your usual pain.

You may or may not obtain improvement in the first few hours after the injection depending upon if the sympathetic nerves are carrying your pain signals.

You may notice increased warmth in the affected extremity for 4-18 hours after the block.

If the sympathetic nerves in the neck are injected (stellate ganglion), you will also notice a slight drooping of the eyelid and redness of the eye for several hours. This is normal, and will resolve over 4-18 hours.

You should report your remaining pain (if any) and record the relief you experience during the next week on a "pain diary" we will provide. Fax, email or mail the completed pain diary back one week after the injection so that your treating physician can be informed of your results and plan future tests and/or treatment if needed.

You may notice a slight increase in your pain lasting for several days as the numbing medicine wears off.

You might also experience mild pain at the injection site for several days. Ice will typically be more helpful than heat in the first 2-3 days after the injection.

You may take your regular medicines after the procedure, but try to limit your pain medicines the first 4-6 hours after the procedure so that the diagnostic information obtained is accurate.

On the day of the injection you should not drive and avoid any strenuous activities.

On the day after the procedure you may return to your regular activities.

You can start your regular exercise program in moderation 3-5 days after the injection.

Even if you are significantly improved, gradually increase your activities over 2-3 weeks to avoid recurrence of your pain.

Cervical, Thoracic or Lumbosacral Spinal Nerve Injection (Diagnostic Transforaminal Injection)

What is a spinal nerve, and why is a selective spinal nerve block helpful?

Spinal nerves exit your spinal cord, and form nerves that travel into your arms or legs. These nerves allow you to move your arms, chest wall and legs. Inflammation of these spinal nerves may cause pain in your arms, chest or legs. These spinal nerves may become inflamed and painful due to irritation, usually from a damaged disc or a bone spur.

A selective spinal nerve block provides important information to your care provider. It helps prove which nerve is causing your pain by placing temporary numbing medication over the nerve of concern. If your main pain area improves after the injection, then the nerve that was injected is likeliest to be causing your pain. If your pain remains unchanged, then that nerve probably is not the cause of your pain. Confirming or denying that a nerve is your exact source of pain provides information allowing for proper treatment of your condition.

What will happen to me during the procedure?

An IV is often started for safety reasons and to give medication for sedation. You will lie down on the procedure table, and the skin over the area to be injected will be cleansed. The physician will numb the small area of skin where the needle will be placed. Next, the physician will use x-ray guidance to direct a small needle next to the spinal nerve. Your doctor will then inject contrast dye to confirm that the medicine flows around the spinal nerve. This may increase your usual pain briefly. Last, numbing medicine will be injected along the spinal nerve to help diagnose if that nerve is the source of your pain. Cortisone (a strong anti-inflammatory) may or may not be injected at the same time, depending upon your doctor’s order.

What should I do and expect after the procedure?

In 20 to 30 minutes after the procedure, you will be asked to try to provoke your usual pain. You may or may not feel improvement at that point, depending on if the nerve that was injected was your main pain source. Because of the anesthetic used, you may have some partial numbness or weakness in the region of your body supplied by the nerve injected. This may last several hours, but you should be able to function safely, if you take the proper precautions. You should not drive the day of the injection. You may take your regular medicines after the procedure, but try to limit your pain medicines for the first four to six hours after the procedure so that the diagnostic information obtained is accurate. You may notice an increase in your pain lasting for several days. This occurs between when the numbing medicine wears off and before the cortisone becomes effective. Ice will typically be more helpful than heat in the first two to three days after the injection.

You may return to your usual level of activity the day after the injection. If your pain is improved, start your regular exercise/activities in moderation. Even if you feel significantly improved, gradually increase your activities over one to two weeks to avoid recurrence of your pain. If there is no improvement in seven to 10 days, then a positive effect on your pain is unlikely. Please record your pain levels during the week following the procedure in a “pain diary,” which we will provide to you. Mail the completed pain diary back as directed, so that your treating physician can be informed of your results, and can plan future tests and/or treatment if needed.