RSD

What is RSD (Reflex Sympathetic Dystrophy) or CRPS (Complex Regional pain Syndrome)?

RSD (Reflex Sympathetic Dystrophy) now known as CRPS (Complex Regional Pain Syndrome) is form of chronic pain that affects the arms or legs. CRPS typically develops after an injury or surgery, but the pain is out of proportion to the severity of the initial injury, if any.
It is not well understood why these injuries trigger CRPS, but it could be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses.
Signs and symptoms of CRPS include continuous burning or throbbing pain, usually in your arm, leg, hand, or foot, sensitivity to touch or cold, swelling of the painful area, changes in skin temperature and color, changes in hair and nail growth, and decreased ability to move the affected body part.
What is a sympathetic plexus block and why is it helpful?

Some individuals with CRPS have pain derived from the sympathetic system. Therefore, blocking the sympathetic plexus of the affected arm or leg could relieve pain in people with CRPS.

If the procedure blocks the sympathetic plexus that innervate the arm, it is called a Stellate Ganglion Block. If the procedure blocks the sympathetic plexus that innervate the leg, it is called a Lumbar Sympathetic Plexus Block.

In our clinic, the Stellate Ganglion Blocks are performed under fluoroscopic guidance. We perform a novel technique developed lately. The advantage of using fluoroscopy (rather than performing the injection blindly, as traditionally done) is that the operator is able to put the medicine exactly at the site of the sympathetic plexus. Theoretically, this technique should increase the effectiveness of the injection.

Also, the fluoroscopic technique makes the procedure much safer because we avoid placing the needle in the spinal nerves, laryngeal nerve, esophagus and the vertebral artery.

What will happen to me during the procedure?

After the physician has administered an intravenous pain reliever, you will lie on your back (if you are receiving a Stellate Ganglion Block) or on your back (if you are receiving a Lumbar Sympathetic Plexus Block).

The skin over your neck (if you are receiving a Stellate Ganglion Block) or over your back (if you are receiving a Lumbar Sympathetic Plexus Block) will be well cleaned.
Next, the physician will numb a small area of skin, which stings for a few seconds.

Then, the physician will use fluoroscopic guidance to direct a very small needle close to the sympathetic plexus. Next, the physician will inject contrast dye to confirm that the needle is placed correctly. Then, the medicine will be slowly injected.

What will happen to me after the procedure?

You will rest in the recovery area for 30 minutes before going home. Your heart rate and blood pressure will be monitored. You will be given instructions regarding your pain, activity, driving, etc.

The injection should help decrease your pain. The procedure can be repeated if needed.