Chemical Lumbar Sympathectomy for Foot Gangrene

The practice known as a lumbar sympathetic blockade is characterized by the injection of local anesthetic or other drugs along the lumbar sympathetic chain. All these nerves are parts of the sympathetic nervous system which is responsible for the involuntary control of certain processes such as blood circulation and perspiration. The block helps especially to chronic pain in the lower limbs where the nerves that carry these signals are disturbed.

Anatomical and Functional Make-Up of the Lumbar Sympathetic Chain

The sympathetic nervous system is among the systems of the autonomic nervous system also responsible for involuntarily controlled cardiopulmonary dynamics, blood pressure, digestive processes, and thermal homeostasis. The lumbar sympathetic chain is lateral to the respective spinal columns on the lower back and nerves extending to the lower part of the body including the lower limbs for pain and its vascular supply.

When performing a lumbar sympathetic block of the spine, the injected material is placed along, to the sympathetic ganglia. By numbing these ganglia, the procedure alleviates the transmission of pain signals from the lower parts of the body to the brain to treat diseases such as complicated regional pain syndrome, or CRPS, reflex sympathetic dystrophy, or RSD, as well as chronic pain in the leg due to vascular or neurological damage.

Indications for Lumbar Sympathetic Block

Performing a lumbar sympathetic block is warranted in several painful conditions that affect the lower limbs, especially in cases where conservative treatment options have not been successful. The most common indications are:

1. Complex Regional Pain Syndrome (CRPS): This is a severe condition in which pain and alteration of the skin or blood supply to a digit or limb following an insult such as injury or surgery is often referred to as reflex sympathetic dystrophy.

2. Peripheral Vascular Disease: Patients with PVD complain of pain and the presence of ulceration on the lower limbs due to inadequate blood supply to the limbs that may culminate into gangrene. The lumbar sympathetic block has been shown to increase blood perfusion to the affected areas and even lessen pain.

3. Chronic Pain Syndromes: There are often severe and chronic pain syndromes in the lower limbs and most of the pain is of neuropathic origin in such cases sympathetic blockade could prove helpful.

4. Post-Surgical Pain: After certain lower limb operations, patients who meticulously follow rehabilitation programs may still suffer from subsequent pain for a prolonged period and sympathetic block may relief this nightmare.

Benefits of Lumbar Sympathetic Block

There are multiple benefits related to the performance of a lumbar sympathetic block, making this procedure of particular importance within the management of chronic pain.

1. Pain Relief: The most obvious advantage is the relief of pain, particularly the pain of CRPS and neuropathic pain. By disrupting sympathetic nerves, the pain is relieved almost immediately as the pain suppressed never reaches the cortex.

2. Enhanced Blood Supply: In the case of peripheral vascular diseases limiting blood supply to the limbs, the lumbar sympathetic block may also cause an increase in blood supply to the limbs by a mechanism called vasodilatation. This is essential for providing oxygen to the tissues and healing ulcers and other open wounds.

3. Diagnostic Aid: A lumbar sympathetic block can be used as a diagnostic procedure to establish the sympathetic origin of the pain. If some relief is achieved with the block, this means that the patient has sympathetically maintained pain.

4. Minimally Invasive: In contrast to surgical procedures, a lumbar sympathetic block is highly minimally invasive, requiring just a needle and local anesthesia. There are no large cuts needed, thus less recovery time, lower chances of infection, and lower risks of any complications.

5. Outpatient Schedule: The operation can generally be done on an outpatient basis, which allows patients to come and go on the same day without significant alteration to their routine.

6. Repeatability: If the block is successful in controlling pain, it can be given to the patient as often as needed for pain maintenance.

Complications of Lumbar Sympathetic Block

The lumbar sympathetic block is deemed low risk; however, there are expected risks and complications with any medically invasive procedure. Some of them are:

1. Bleeding or Hematoma: As this is a semi-invasive procedure involving the use of a needle, there is a high likelihood among blood thinners patients, or patients with clotting disorder, to have bleeding or, more so, formation of a hematoma at the very injection site.

2. Infection: The use of a needle into the skin presents an infection risk. This risk is particularly minimized with the use of strict sterile techniques and the probability of them occurring is very low, nonetheless, such situations may happen.

3. Nerve Injury: The needle may be misdirected and damage the nearby nerves to cause nerve injuries although this is very rare.

Lower limbs may be affected and symptoms such as numbness, tingling, or weakness may occur.

4. Allergic Reactions: Some individuals may experience allergic reactions associated with the anesthetic or other drugs given alongside the block. Skin rashes of mild severity may be seen or more severe reactions such as that associated with anaphylaxis may be encountered.

5. Causes of Low Blood Pressure: Specifically, the lumbar sympathetic block can lead to hypotension (low blood pressure) due to the effect of the block on sympathetic nerves, which causes blood vessels to dilate and may sometimes cause fainting or lightheadedness.

6. Volitional Bladder or Bowel Control Impairment: If the blockade impacts the nerves that innervate the bladder or bowel, the patient may also experience some loss of these controls. This complication tends to be short-lived and self-resolving.

7. Lack of Relief from Pain — Contradictory cases are also prevalent when the block does not alleviate the pain as expected due to various reasons: the pain may be refractive to sympathy for the most part or there may be technical difficulties during the procedure.

Experience of Dr Sandeep Sharma and Team

Dr Sandeep Sharma, Head of IR Facilities, has 16 years of immense expertise in interventional radiology and neuro-interventional procedures. Very few can match his minimally invasive technique which includes lumbar sympathetic block, a procedure which his team is given utmost care and priority of performing.

What Makes Dr. Sharma’s Lumbar Sympathetic Blocks Stand Out:

1. Highly Experienced Team: Under the guidance of Dr. Sharma, his team has mastered different pain management strategies, especially the use of sympathetic blocks. They have the expertise that enables them to determine with much degree of accuracy, the likelihood of a given sympathetic block controlling a patient’s pain and provide appropriate treatment.

2. Advanced Imaging Technology: The needle placement close to the sympathetic ganglia is one of the integral components that engenders the success of lumbar sympathetic blocks. The team of Dr. Sharma performs under fluoroscopy or ultrasound guidance to accurately place the needle, thus reducing the possible complications while increasing the efficacy of the block.

3. Comprehensive Patient Assessment: Prior to undertaking the procedure, an assessment of the pain history, medical history, and physical health of the patient is performed by Dr. Sharma’s team. This enables the healthcare practitioners to determine that the lumbar sympathetic block is the safest and most effective therapeutic option, hence minimizing possible complications.

4. Minimally Invasive Techniques: Interventional radiology is one of Dr. Sharma’s greatest skills, and thus, he and the rest of the team have a focus on interventions that manage pain with minimally invasive procedures only. This helps to shorten the duration of healing from the procedure for patients, as well as reduce the dangers involved with more extensive surgical operations.

5. Post-Procedure Monitoring and Care: After the block, Dr. Sharma’s group also pays close attention to the patient’s response, including detailed post-operative care instructions to facilitate recovery and pain reduction. Consequently, further blocks may be arranged should there be a need to control pain at a given level.

6. Patient-Centered Approach: Dr. Sharma’s team is committed to individualized care — factoring in the particularities of each patient’s status and requirements. Their mission is not only to alleviate suffering but to enhance the patient’s life by restoring movement and function.

Conclusion

Pain Management is one of the proven indications for lumbar sympathetic block. It is especially effective for chronic pain of lower limbs caused by CRPS, peripheral vascular disease, neuropathic pain disorders, etc. It has several benefits including that of relieving pain and improving blood supply to the region with very few risks associated with the technique as it is a minimally invasive procedure.

Dr. Sandeep Sharma has vast experience in interventional techniques and is head of the IRFacilities team which performs lumbar sympathetic blocks very effectively. With the help of advanced imaging techniques and focus on the patient, it is assured that the highest quality care is provided leading to aesthetics and improved quality of living. Whether performed as a diagnostic procedure or as part of the management of chronic pain strategy, lumbar sympathetic blockade done by Dr. Sharma and the team proves to be of great value to patients with chronic pain diseases.