Sympathetic nerve blocks overview

Interrupting pain signals through the sympathetic nervous system

Sympathetic nerves control autonomous functions of the body, meaning functions that are not consciously controlled, such as heart rate, sweating and blood flow.

These nerves run down the spine along a separate pathway from the spinal cord and are located towards the front of the spine. Pain signals can also travel through the sympathetic nervous system. Sympathetic nerve blocks are generally used to treat neuropathic pain.

The procedure temporarily interrupts pain signals by injecting local anaesthetic directly around the sympathetic nerves. It may be used diagnostically to help characterise the pain or therapeutically to help treat it. In some cases, a sympathetic nerve block or a series of blocks may provide prolonged pain relief.

Common sympathetic nerve blocks include stellate ganglion blocks for pain affecting the face or arm and lumbar sympathetic blocks for the legs and some abdominal organs.

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Sympathetic nerve block indications and preparation

Preparing for your sympathetic nerve block

A sympathetic nerve block may be recommended for:

  • Neuropathic pain.
  • Complex regional pain syndrome.
  • Chronic visceral pain.
  • Hyperhidrosis, or excessive sweating.
  • Some vascular insufficiency syndromes.

You should avoid undergoing any other medical procedures, such as dental treatment or a colonoscopy, within 48 hours before or after a sympathetic nerve block.

You should also not have anything to eat or drink prior to the procedure.

Please let us know ahead of the procedure if:

  • You are taking any antibiotics.
  • You have a pacemaker or defibrillator.
  • You have any allergies.
  • You are diabetic.
  • You are ill, in which case we may need to postpone the procedure.

You should not drive yourself to or from the appointment, or drive during the 24-hour period immediately after the procedure.

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Sympathetic nerve block procedure

What to expect during your procedure

The procedure uses fluoroscopic X-ray guidance to accurately position the injection, with light sedation available if required.

1. Injection location

For a stellate ganglion block, the injection is made at the front of the neck. For a lumbar sympathetic block, it is made beside the bony lumbar spine.

2. Positioning and IV preparation

You will lie on a fluoroscopy table while an IV line is placed in your arm or hand in case light sedation is required.

3. Injection site preparation

The injection area is cleaned and numbed with local anaesthetic before a thin needle is inserted.

4. Fluoroscopy-guided placement

The needle is guided into the correct position using real-time X-ray imaging.

5. Contrast and anaesthetic injection

A small amount of contrast dye is used to confirm the target area before the anaesthetic is injected.

Recovery and pain assessment

You will remain under observation for around 30 minutes and report whether your usual pain has reduced and by how much.

Sympathetic nerve block risks

Possible complications to be aware of

A sympathetic nerve block is a relatively low-risk procedure – however all medical treatment comes with some level of risk. Possible complications may include:

Infection

A small risk of infection is present.

Pain at injection site

Temporary soreness may occur where the needle was inserted.

Damage to adjacent structures

Rarely, nearby anatomical structures may be affected.

Allergic reaction

A reaction to the anaesthetic or contrast dye may occur.

Ready to take the next step?

  • Comprehensive pain assessments
  • Individual treatment planning
  • Medication review and optimisation

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