The sympathetic nervous system is comprised of nerves that start from the spinal column and branch out. These nerves help control our internal organs, such as the dilation of our pupils, constricting blood vessels, heart rate acceleration, widening of bronchial passages for increased oxycgen, and activation of sweat glands to produce prespiration. The sympathetic nerves also help in feeling certain sensations, such as heat, cold and pain. These nerves bundle together and are called a ganglion, stellate ganglion for the upper body and sympathetic ganglion for the lower body. Sometimes these nerves can become injured or irritated and can produce many problems including restriction of blood flow to your extremities and sensory changes, including pain.
Prior to starting the sympathetic ganglion block, the doctor will usually start intravenous sedation to make you more comfortable. Then a local skin anesthetic is used to numb up your skin and underlying tissue. Using x-ray guidance with the fluoroscope the doctor can inject a combination of local anesthetic (such as lidocaine) and a steroid (such as kenalog) into the space where the sympathetic ganglion are located. This procedure is diagnostic as well as therapeutic. For RSD/CCRPS, your pain and other symptoms would immediately improve after the block. Additional blocks would then be scheduled for continued treatment.
There are minimal risks associated with these blocks, which makes them an appropriate and safe treatment for RSD/CCRPS. Complications can include bleeding, infection, pneumothorax, nerve damage, and pharmacological complications from the medications used during the procedure.
Sympathetic ganglion blocks are very effective at treating RSD/CCRPS, especially in combination with other therapies (such as neuropathic medications and physical therapy).