This is what I am had done today

 

                                        Sympathetic Nerve Blocks:

There are three reasons to consider sympathetic blockade to facilitate the management of RSD / CRPS. First, the sympathetic block may provide a permanent cure or partial remission of RSD / CRPS. Second, by selectively blocking the sympathetic nervous system the patient (and physician) will gain further diagnostic information about what is causing the pain. The sympathetic block helps determine what portion of the patient's pain is being caused by malfunction of their sympathetic nervous system. Third, the patient's response to a sympathetic block provides prognostic information about the potential merits of other treatments. ^25-27

There is evidence that there might be a role for sympathetic blocks in preventing RSD / CRPS. A retrospective study demonstrated that the prophylactic use of sympathetic blocks in patients with a history of RSD / CRPS decreased the occurrence rate of the disease from 72% to 10% after re-operation on the affected extremity. ²⁸

If sympathetic blocks are not properly performed and evaluated, time and money will be wasted, and diagnostic-prognostic information will be lost. A good sympathetic block should increase the temperature of the extremity without producing increased numbness or weakness. The sensation of warmth tells the patient that they have had a sympathetic block. If the block causes numbness or weakness, more than just the sympathetic nerves were blocked and the patient will get an overestimation of the amount of their pain that is contributed by their sympathetic nervous system; hence, the diagnostic and prognostic value of the nerve block would be lost. The amount of pain relief and improvement in range of motion and in exercise tolerance should be noted by the patient and recorded by the physician. This information about the patient's response to sympathetic blockade will serve as a prognostic indicator for rehabilitation following the series of sympathetic blocks and it will help the patient decide if a permanent block (destruction of the nerve by sympathectomy) would be appropriate. Also, the information will aid in directing future medications in a more rational manner. Some patients will experience a "booster effect" with each sympathetic block, i.e. each successive sympathetic block in the series provides greater and greater pain relief and improvement in exercise tolerance. The maximum sustained benefit from a series of sympathetic blocks is usually apparent after a series of 3-6 blocks. Even if the original site is unresponsive to sympathetic blockade, future exacerbation of RSD / CRPS symptoms at the same site or at a distant site may be responsive to 1-3 sympathetic blocks. THE GOAL IS ALWAYS TO TREAT BUT DON'T OVER TREAT.

Sympathetic blocks are usually performed by a pain specialist trained in anesthesia. In experienced hands, these nerve blocks can be performed with minimal discomfort to the patient with or without IV sedation. Complications from sympathetic blockade are extremely rare. However, it is always possible for the local anesthetic to be inadvertently injected into a blood vessel or into the spinal fluid. If this should happen, the patient may temporarily become weak and lose consciousness. For safety reasons, sympathetic blocks are always performed under conditions where the vital signs (blood pressure and breathing) can be monitored closely. Patients should not eat for 6 hours prior to a sympathetic block. For further information about safety in performing nerve blocks refer to the web site for the Anesthesia Patient Safety Foundation: http://www.apsf.org/

A sympathetic block of the upper extremity is called a stellate ganglia block (SGB). The SGB is performed by inserting a small needle along side the windpipe (trachea). Patients are informed that they may notice a temporary change in the tone of their voice following the block because some of the local anesthetic may partially numb the vocal cords. They are also informed that they should sip fluids and take small bites of food immediately after the block. The numb ness around the vocal cords temporarily places the patient at a slight risk of coughing in response to drinking and eating. The patient may also notice a temporary drooping of their upper eye lid due to the SGB (Horner's sign). A sympathetic block of the lower extremity is called a lumbar sympathetic block (LSB). For patient comfort and safety, LSBs should be performed with the aid of a fluoroscope (X-rays). Videos of LSBs and SGBs being performed can be found below at the end of this section.

As noted previously in the Guidelines, there may be point-tender spots in the muscles of the affected region due to small muscle spasms called muscle trigger points (myofascial pain syndrome). The patient may obtain significant relief of the diffuse pain due to RSD / CRPS from a sympathetic block but the pain due to muscle trigger point(s) may persist. Local injection of local anesthetic into the trigger point region and/or application of physical therapy techniques after a sympathetic block may be necessary to provide further relief of pain.