What is a lumbar sympathetic block ?

A lumbar sympathetic block is an injection of local anesthetic into the back using X-ray guidance. With this procedure, we are blocking the sympathetic nerves to your leg. These nerves typically are not responsible for sensation, but they can be "turned on" in certain pain syndromes.

This procedure is typically ordered by your doctor for pain located in the buttocks and/or legs that is caused by sympathetically maintained pain, or complex regional pain syndrome, formerly known as reflex sympathetic dystrophy (RSD). It may also be ordered for nerve injury or post-herpetic neuralgia (herpes zoster, shingles). Lumbar sympathetic blocks are also used with circulation problems (e.g., vascular insufficiency) to see if blood flow can be improved.

Lumbar sympathetic blocks may have therapeutic or diagnostic value. One of two things will happen:

1. The pain does not go away, and there is evidence of a sympathetic block. The fact that the pain is unresponsive to sympathetic blocks is of diagnostic value.

2. The pain goes away after the injection and stays away longer than the life of the local anesthetic. This means the block was of therapeutic value.

This procedure will most likely have to be repeated to produce a long-lasting benefit. The spacing of injections will be based on how long the pain relief lasts between injections. Typically, you will experience a longer benefit following each subsequent injection. We also may decide to "destroy" the sympathetic ganglion using radiofrequency energy if you obtained excellent, but temporary, relief.

What is a celiac plexus block ?

The plexus is located along the side of your spine.

Alcohol is injected to destroy the nerves when a neurolytic block is performed, usually for patients with cancer.

A diagnostic block is often done prior to a neurolytic block to ensure that pain relief can be achieved by this type of injection. Your doctor will tell you if you are an appropriate candidate for a neurolytic block.

CT scan picture showing needle positioning for coeliac pexus block

What is a stellate ganglion block ?

A stellate ganglion block (sympathetic block) is an injection of local anesthetic into the front of the neck. It is typically ordered by your doctor for pain located in the head, neck, chest or arm that is caused by sympathetically maintained pain (complex regional pain syndrome), causalgia (nerve injury), herpes zoster (shingles) or intractable angina. Stellate ganglion blocks are also used with circulation problems, particularly Raynaud's or complex regional pain symdrome (CRPS), to see if blood flow can be improved.

Stellate ganglion blocks may be of therapeutic or diagnostic value. One of three things will happen:

• The pain does not go away, but there is other evidence of a sympathetic block, meaning the pain is not responsive to sympathetic blocks. This is of diagnostic value.

• The pain does not go away and there is no good evidence of a sympathetic block, meaning the block is a technical failure.

• The pain goes away after the injection and stays away longer than the life of the local anesthetic, meaning the block was of therapeutic value.

The procedure will most likely have to be repeated to achieve a long-lasting benefit. The spacing of injections will be based on how long the pain relief lasts between injections. Usually, you will experience a longer benefit following each subsequent injection

Left hand CRPS

Left Stellate ganglion block - note the spread of dye along the ganglion

What is a superior hypogastric block?

A superior hypogastric block is an injection of local anesthetic and steroid around the sympathetic nerves which supply the organs of the pelvis.

These nerves are located on either side of the spine in the lower abdomen. After successful diagnostic injection RF ablation or alcohol neurolysis can be performed to provide long lasting pain relief.

What is Spinal Cord Stimulation (SCS) ?

This procedure is for patients with spine and extremity pain that has not responded to other treatments. SCS is a technique that uses tiny electrical leads to block pain signals. These leads are placed over the spinal cord where the pain signals are converging. Temporary leads are placed initially, and a permanent system can be implanted if the temporary leads result in significant relief over a 3 – 5 day trial period. Once implanted it is useful for almost up to 8-10 years because very advanced battery with life up to 10 years.

The commonest indications are

• Failed back surgery syndrome (Pain after spine surgery) - FBSS

• Vascular ischemia leading to severe pain or impending amputation of the limbs (can avoid amputation in most cases),

• persistent angina pain in spite of optimum medical, interventional & surgical treatment,

• Post herpetic neuralgia etc.

Animated Picture of stimulations by SCS

X-ray view of SCS

What is Gasserian Ganglion RF ablation ?

The Gasserian Ganglion can be partially ablated as it sits in Meckles Cave either by using Glycerol or by making a radiofrequency lesion.

A small thin needle is inserted into the middle of the cheek under local anaesthesia, and gently guided with X-ray assistance through the foramen ovale into Meckles Cave where the Gasserian Ganglion sits.

It is important to treat the correct branch of the trigeminal nerve involved in the pain, to avoid excessive numbness post-procedure. With latest RF generators we can stimulate to confirm the branch which is to be ablated. This improves the effectiveness of the therapy

For patients where surgery and anaesthesia is too risky, Injection Techniques may offer pain relief.

What is Vertebroplasty ?

What is Intrathecal/Spinal Drug Delivery Systems ?

A Computerized pump that delivers opiates, local anesthetics and other pain medication continously into the intrathecal space to control infractable pain.

Also, this infusion system can be used to relieve infractable spascity (Inj. Baclofen) secondary to disease like multiple sclerosis, celebral palsy, stroke or spinal cord injuries.

Pump implantation in progress

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