Lumbar Sympathectomy

  • Reference Number: HEY-611/2014
  • Departments: Pain Medicine

Introduction

This leaflet has been produced to give you general information about your treatment.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for further discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a Lumbar Sympathectomy?

A lumbar sympathectomy injection is one method used to provide pain relief by blocking the pain-inducing sympathetic nerves in the lumbar (lower) region of the back. Sympathetic nerves are responsible for controlling the automatic functions of our body’s skin temperature, but can also be responsible for increasing pain we experience from an injury, long after the injury has healed.

Advice to be read before having a pain relief procedure?

The following information has been produced to ensure that you are able to have a pain relief procedure. It is essential that you read and follow the advice given below before you come to the hospital.

You will be required to attend a pre-admission assessment / Meticillin-resistant Staphylococcus aureus (MRSA) screening before your procedure. It is important that you attend this appointment as failure to do so may result in the delay of your procedure.

Please contact the Pain Clinic if any of the following apply to you:

  • You have recently had an admission to hospital.
  •  You have tested positive for MRSA.
  •  You have an infection and are currently taking antibiotics.
  •  You think you may be pregnant.
  • You are diabetic and take medication to control your diabetes.

Please continue with your other regular medications including your pain killers except for anticoagulants (please see below):

If you take Warfarin (Marevan), Clopidogrel (Plavix), Dipyridamole (Persantin Retard), Phenindione, Pradaxa, Xarelto, Sinthrome or Asasantin Retard, please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this.

Your stay may last between 2 – 4 hours so please bring something to read or to do, to keep yourself occupied.
Please leave any valuables or jewellery at home. It is essential that after the procedure you arrange for an adult friend or relative to collect you by car or taxi. You will not be able to drive or use the bus or train to travel home.
Hospital transport may be available if there is a medical need. If you think you may be eligible please contact your GP surgery.

Advice for diabetic patients only:

Please inform the clinic staff as soon as you arrive that you are diabetic. During your pre-assessment, a member of nursing staff will discuss your diabetes and diabetic medications/regime with you. They will provide advice as to how to take your diabetic medications on the day of your procedure, depending on the time of day your procedure is booked for. They will also provide advice on being nil by mouth, prior to your procedure.

Morning procedures should not have breakfast. Morning medications can be taken with a small sip of water, unless advised otherwise.

If you are booked for treatment in the afternoon please have your breakfast and take regular medications before 7.00am. Clear fluids such as tea or coffee (without milk), water or sugar-free squash can be taken, up to 10.00am.

Before the procedure

Treatment takes place as an outpatient at the Day Surgery Theatres, Ward 4 Castle Hill Hospital (CHH). You will have either a morning or an afternoon appointment.

On arrival, you may be asked to complete questionnaires as part of an audit and to record improvements in pain levels. You will be asked to change into a theatre gown and your blood pressure and pulse will be recorded.

Your doctor will then discuss the procedure with you and ask you to sign a consent form, if you understand the procedure and any possible risks / side effects.

The procedure

In the treatment room, you may have a small needle (cannula) placed in the back of your hand. This allows the doctor to give you sedation and/or intravenous (infusion of liquid substances directly into a vein) fluids if necessary.

Once you are lying in the correct position the doctor will clean your back with an antiseptic solution which can feel very cold. The procedure will be carried out under X-ray screening.

Local anaesthetic is injected into your back, which may sting at first, but the area will soon go numb. Contrast (a solution which shows up under X-ray) is injected to make sure that the needle is in the correct position as seen on X-ray. Once this is confirmed local anaesthetic is injected and you may feel your leg begin to warm.

Following the procedure

After the procedure you will be taken to the recovery area where the nursing staff will observe you and monitor your blood pressure and pulse. You may feel a little drowsy and wish to sleep. This is normal. Your legs may feel warm; the nursing staff will monitor any changes in temperature. You will lay flat for about 45 minutes and then be assisted to sit up and offered light refreshment. Before you leave, the doctor will see you again and ask a few questions about your pain and any effects that the injection may have had.

Please ensure that you have arranged for someone to drive you home after this procedure. Failure to do so will result in your procedure being cancelled.

If you have had sedation, we recommend that you arrange for someone to stay with you overnight and that you do not drive for 24 hours.

Possible side effects

Not all the nerves leaving the vertebral column (backbone) carry pain messages. Some carry instructions to muscles in your legs. If these nerves are numbed by the injection then your legs can become heavy or weak. This side effect will only last a short time.

What to expect afterwards

Some immediate relief of your pain may be noticed due to the local anaesthetic but some tenderness may be felt at the injection site. Take your regular pain killers as normal. Try to keep on the move about the house but do not do anything too strenuous.

As your pain decreases you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike or swimming on your back will help to improve your muscle tone and strengthen your back. The best way is to increase your activity slowly.  Try not to overdo things on a good day as this may result in you experiencing more pain the following day.

Follow Up

A letter will be sent to your GP and you will be reviewed either by telephone or seen at the Pain Clinic in due course.

Points to remember

  • You will need to arrange for someone to drive you home after this procedure.
  • Please bring your glasses if you need them for reading.
  • Always bring a list of all current medication and diabetic medications, if appropriate. Also bring a sugary drink / glucose tablets, if you are diabetic, in case this is needed.
  • Continue taking all your usual medication on treatment day unless advised to omit anything by the Pain Clinic.
  • If there is any possibility you may be pregnant please inform the doctor or nurse.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.