c2- Thoracic Sympathetic Block

What is the thoracic sympathetic nerve, what is its function, and where is it located?

The dorsal sympathetic nerves emerge from the sides of the thoracic vertebrae. These nerves control the sensation of pain and blood flow to the arms.

In which diseases is thoracic sympathetic block applied?

• Complex regional pain syndrome, particularly pain radiating to the arm

• Shoulder-arm syndrome • Neuropathic pains

 • Raynaud's disease

• Hyperhidrosis, excessive sweating

Anatomy of the thoracic sympathetic chain

What preparation is required for the procedure?

No food or liquid should be taken 4 hours before the procedure. However, you should take any medications you are on for other illnesses with a small amount of water if your doctor permits. Come to the procedure without jewelry such as necklaces, earrings, watches, rings, bracelets. You should also come with a relative who can accompany you after the procedure.

What are the benefits of the procedure?

 Generally, pain begins to decrease within 15-20 minutes after the procedure. Also, as blood flow to the affected arm increases, the temperature of the arm begins to rise.

How is it administered?

Before the procedure, you will be asked to sign an informed consent form as a legal requirement. A vascular access is established for the patient, who is then taken into an operating room environment where pulse, blood pressure, blood oxygen level, and respiratory measurements are taken. These values are continuously monitored throughout the procedure.

The patient lies face down, and sedative drugs are administered through the vascular access. The area is cleaned with antiseptic solutions and draped. The entry point of the needle on the back is determined and verified through an imaging device. After numbing the entry site with a local anesthetic, a dye is administered to re-verify under the imaging device, and a local anesthetic with a steroid mixture is injected to perform the block.

Thoracic sympathetic block

 

What can happen after the procedure?

Entering the blood vessels in the area of intervention can cause bleeding, and contact with the pleura can cause coughing. In addition, injury to the esophagus or trachea may occur. However, all of these are extremely rare. If the imaging device is used correctly, these complications are virtually nonexistent. Immediate reduction in pain and other symptoms after the procedure indicates its success.

What is the purpose of the thoracic sympathetic block?

The block aims to block the nerves of the sympathetic nervous system in the back region. Blocking the sympathetic nerves can reduce complaints such as pain, swelling, redness, and sweating and improve arm movements.

How long does the procedure take?

The procedure takes 15-20 minutes and is performed in an operating room environment.

Is the procedure painful?

During the procedure, both the needle entry site is numbed, and sedative drugs are administered through a vascular route. Therefore, you do not feel pain.

What should I do after the procedure?

Rest is recommended for 4-5 days after the procedure. You can meet your needs such as eating, toileting, and bathing. Besides these activities, you should rest continuously in a comfortable lying position. A report is given to working patients to excuse them from work.

Can I go back to work the day after the procedure?

Since four to five days of bed rest is required, a report is given to working patients.

How long does the effect of the procedure last, and how many injections are needed?

Analgesic effectiveness lasting for months can be achieved after repeated blocks. Some patients may achieve treatment with 1-2 injections, while in others, it may have no effect.

Will the block benefit me?

It cannot be predicted in advance how it will affect each patient. While its effectiveness is higher in patients who apply in the early stages, there is a lower success rate in patients who have had symptoms for 6 months or longer.

What are the risks and side effects?

Although the procedure is very safe, risks, side effects, and possible complications that can occur with all other interventions can rarely occur with Thoracic Sympathetic Block as well. The most common side effect is pain at the site of the intervention, which is temporary. Other risks include bleeding, infection, injection into nearby vessels or organs, epidural or spinal injection, hypotension, temporary loss of sensation in the arm. These side effects are extremely rare.

Who should not undergo a Thoracic Sympathetic Block?

It is not administered to those who have an allergy to the drugs used during the procedure, those who take blood thinners such as Coumadin, Plavix, or patients with an active infection in the area to be operated on or anywhere else in the body.