Sympathetic Nerve blocks - the good, the bad and the ugly
 

My PM doctor is recommending a sympathetic nerve block (or blocks?) for my CRPS. I have browsed posts on this site and seen everything from it cured my life to it made it worse so I'm asking for more updated information since it's been some time since others posted. If you've had one 1) what can I expect (Can I really go back to work that afternoon?? How long does it take? Did you get sedated? Does it hurt? How was your recovery?) 2) did it help or make things worse? and 3) would you do it again. Thanks in advance!!

I really didn't want to go the block-route because I had read several places that if a block should go wrong on RSD, it messes with the sympathetic nerve system so bad that it could potentially worsen the RSD. So if one doesn't go well, it could be a potential hazard.

I don't know if insights around this have changed in recent years.

I do know, however, that they get done, and routinely at that!

Thanks Marleen!! What combo of pain meds are you using today instead? My new regimen is helping and definitely heading in the right direction but not 100% yet. I think I may need some sort of long acting opiate as opposed to IR since I only get a set period of relief with that.

I had a couple of blocks. The first was a little more than 6 months after my injury and it had very little impact on my rsd...the temperature changes were reduced significantly afterwards but pain remained about the same. No negative reactions. 2 years later I had a series of blocks done...and the last block caused me to get worse and my rsd to spread to almost full body. I am mad at myself because I let the dr bully me into it when I didn't really want the treatment...but it's on me for letting myself get pushed around. I think getting worse is pretty rare...and any treatment can make you worse so this is not a huge thing to worry about...but it is a risk even if a small one and it does happen. Blocks seem to generally be MOST effective in the first 6 months and can help people achieve remission. But like everything else you need to look at the positives and the negatives and decide if it's worth the risk. I had bad luck but far more people do have success and relief from the treatment.

This past September 13th I had a discectomy at L5-S1; it was successful and I was feeling great. A week later I was in the ER with sepsis, C. Difficile, and, what was finally diagnosed on September 30th, CRPS. It is affecting my left foot. The neurosurgeon who did the discectomy is treating me; he believes it was his surgery that triggered the CRPS. He has me on Lyrica and he has arranged with the Pain Center at the hospital for me to get a "series" of nerve blocks. I found out a "series" is three. The first was on November 1. To answer your question, I'm doubting you can go back to work in the afternoon. The hospital required me to have a ride home. The procedure was scheduled for a half hour, but you know darn well that with check-in etc, you'll be there longer. I was not sedated; I was prepped with antiseptic and then the doctor administered Lidocaine to numb the area and then "the shot". While I knew something was going on back there, it really didn't hurt. I was told that it would take "a few days to a few weeks" before I felt any improvement. And indeed, after two weeks I felt considerably better. I have the second one scheduled for December 7th, or sooner if there's a cancellation. I will also admit that I am taking CBD oil; 15 mg in the morning and 25 mg at night. The doc that did the spine shot suggested it. Right now I have very little pain. My foot still swells but nowhere near like it did before. My foot still turns a bit red but not almost blue like it did before. Bottom line: I'm doing okay.

So there was no sedation at all?? No way I will be able to lay still and let them use a giant needle without some sort of sedating medication. What medications were part of your injection? Just curious how my planned injection stacks up. I think they said I could choose to have sedation and if that's the case I absolutely will.

As I wrote yesterday: "the doctor administered Lidocaine to numb the area". That's your "sedation". The doc told me that "the shot" was roughly half anesthetic and half steroid.

Wondering if mine will be different then since I told them no cortisone whatsoever due to a previous adverse reaction. But heck, if there's no sedation I'll be walking out of that office sans injection. Going to call them today!

Here's exactly what the doctor did:

Patient laid on the fluoroscopy table in the prone position.
Procedure Details:
Body area: trunk
Location: sympathetic

Needle size: 22 G
Location technique: anatomical landmarks (Fluoroscopic guidance)
5 mL iohexol 300 mg iodine/mL; 10 mL bupivacaine PF 0.25% (2.5
mg/mL); 5 mL lidocaine PF 1% (10 mg/mL)
Patient was prepped and draped in the usual sterile fashion.
Post-procedure Details:
The patient was observed in the ambulatory surgery department.
Instructions: post-procedure instructions were reviewed
The patient discharged from the clinic in stable condition.

Originally the doc told me he was injecting a steroid. He didn't. The bupivacaine is an anesthetic.

I had my second shot this past Friday, 12/7/18. As with the first, I was told it would take a few days to a few weeks before I noticed additional improvement. A third shot is scheduled for early January "if I need it". If I don't I've been told to just call and cancel. At the end of the month, I have my first visit with my PCP since all this happened. We'll discuss PT at that time. Additionally, if need be, he has found a doctor in the area who is a psychiatrist and a neurologist who treats CRPS patients. The fingers remain crossed!

Did it help you? So far it's done nothing for me but I have my second injection tomorrow. Fingers crossed it works because I'm at a loss as to the next steps beyond just dealing with it. I definitely don't want to do the SCS. It's tolerable-ish most of the time with meds, I guess.

Mike,

How did you get over C-diff? Are you accessing Boston Pain Management or are you using a local facility?

The first one helped. It took about two weeks before the effects were felt but the pain subsided considerably. I don't get the purple foot I used to get from standing for half an hour. It still swells and by night time It gets stiff, but otherwise, it's a lot better than before. The second shot included prednisone:

Patient laid on the fluoroscopy table in the prone position.
Procedure Details:
Body area: trunk
Location: sympathetic

Needle size: 22 G
Location technique: anatomical landmarks (Fluoroscopic guidance)
5 mL lidocaine PF 1% (10 mg/mL); 10 mL bupivacaine PF 0.5% (5 mg/mL);
5 mL iohexol 300 mg iodine/mL; 40 mg methylPREDNISolone acetate 40 mg/mL
Patient was prepped and draped in the usual sterile fashion.
Post-procedure Details:
The patient was observed in the ambulatory surgery department.
Instructions: post-procedure instructions were reviewed
The patient discharged from clinic in stable condition.

Sorry to say these did not work for me...wanted to update for anyone else reading this. Now debating between ketamine, a SCS or doing nothing.

The c. dif was taken care of in the hospital, UMass Memorial. I was there for thirteen days. Intravenous Vancomycin for three days as well as orally for two weeks. I ordered yogurt with every meal and it was suggested that, once home, I take a probiotic.

Tky. I asked, because I wondered if you needed a fecal transplant. I am considering one, not for C-Diff which I do not have, but for CRPS. My stomach issues, began right after my accident that triggered CRPS, so I am hoping that restoring my lower bowel microbiota might help with a remission.

Blocks
 

I have a had 175 plus blocks in the upper and in the last 5-10 years it has spread to my legs so know I'm getting blocks for the legs know, I find that i have a harder time getting the lower done than the upper ones. but it is the the only thing that has help with the pain .