Let’s start with the simple question that is likely on your mind, what is a sympathetic ganglion nerve block, and what is a sympathetic ganglion? In its simplest form, the sympathetic ganglion block is the injection of local anesthetics (like Lidocaine or Marcaine) at the site of a specific ganglion. Sympathetic ganglia or paravertebral ganglia are hubs for afferent and efferent nerve cell bodies. Which ganglion to block depends, traditionally, on the area that you are trying to affect. For example, if a patient is having severe neuropathic pain or symptoms in the feet, then the ganglion that you would likely want to target lies anterior to the spinal nerves at L4.
The procedure is done using small spinal needles. The process is simple, and I’ll walk us through it. The patient will enter the procedure suite or operating room and lay face down on a radiolucent table. Then, the x-ray technician will line up the target sympathetic ganglion by rotating the fluoroscopy (x-ray) unit clockwise, called an oblique view. Once the target is identified, a small pinch will be felt on this skin, this is numbing medicine at the skin a slightly deeper. Now that the skin is numb, a spinal needle will be introduced into the numb spot on the back, a few centimeters off of the midline. The needle will be angled anteriorly (towards the front) and medially (towards the center). Once the spinal needle has been advanced, the x-ray technician will further rotate the fluoroscopy unit so that we can obtain a lateral image (think of a picture that goes from the left to the right side). This picture will show us the depth of the needle. We want to be near the front edge of the vertebral body. Once the needle is in the final location, we will inject some contrast (or alternative) dye to verify the location. Now, the physician will administer the local anesthetic at the ganglion in small increments. With the medication administered, the needle will be removed in its entirety.
The process is so simple that most decide that sedation isn’t necessary, you can still opt to be sedated if you choose. The results should be a rather quick decrease in your symptoms, less pain, less burning or cold feelings, fewer pins and needles, decreased feelings of a pebble under the foot. The traditional neuropathy aliments should subside temporarily. With Lidocaine, the symptoms will abate for 2-4 hours, this can be extended by the use of Bupivacaine or Ropivacaine. Regardless of the local anesthetic agent chosen, what matters most is the relief that is obtained. If there is noted relief, a similar procedure, called a radiofrequency ablation, can increase the longevity of this relief for 6-18 months.
Complications are extremely rare but do exist. Of the rare complications, the ones that are most likely to occur are bleeding, nerve damage, and infections. These complications are extremely rare for several reasons. First of all, the skin is cleaned with an antiseptic agent preventing infections. Nerve damage and bleeding are unlikely due to the use of visualization with the fluoroscopy unit. With this machine, we can see the bone structure and the needle to make sure the needle is located in a safe place. This procedure has been fantastic for most with neuropathy pains. While this procedure is effective, it is no guarantee that it will completely reduce your symptoms.