Nerve Blocks

Description

Notes

Comments

I want some information but nerve blocks so I can go to my GP and say "this is how they treat this condition, and can you do it for me?"
I am basically tried of the pain. Every specialist I have been to, doesn't believe in nerve blocks, so this is why I want to find some information on it... I have been to the top pain clinic in New Zealand and all they offered me was a week of physio. The doctor was a bit of a joke, as he seemed to think it was all in my head (god I am sick of them) so I have been looking for another specialist. My RSD is covered by ACC (a kind of medical insurance we have in New Zealand) so I have been lucky in that respect. But, I am sick of taking pills all the time. Lynda - Dunedin, New Zealand

I have undergone 13 Lumbar Sympathetic Blocks in a 15 week time period. The pain is not completely eliminated; however, it does make it tolerable. The problem is that I have them done on Mondays and they last through Friday evening. The weekend is bad. Even so, I would still rather have the blocks once per week in order for me to have at least three to four days of relief. My blocks are done by my anesthesiologist at a pain management center in Denver, Co. He begins an IV drip and injects some pain relievers. Then a needle is injected into the ganglia (where the sympathetics come together near the spine by the L2 vertebrae). It is pretty uncomfortable, but it does make a difference to me for the next few days. Considering I have had no luck with any drugs making a difference in my pain level (other than some narcotics, which I can't be on all the time), the nerve blocks are the only thing that keeps me going. What I have found out is that not any anesthesiologist can perform a nerve block. So people really need to look for one with experience with them. Annemarie - Colorado, USA

I have had seven intravenous Guanethidine blocks in the last couple of months so I may be able to give you a little info although it is totally subjective. I have RSD in my lower left leg, foot and ankle. In my case a tourniquet was placed around my thigh to cut the blood supply off to my leg and the drugs were inserted through a needle in my foot. The tourniquet in itself can be quite unbearable but the insertion of the needles was quite horrendous. I can't think why they would want to put needles into an already hypersensitive area and unfortunately I had to have this done with no anaesthetic - it wasn't pleasant to say the least. The drugs themselves cause a burning sensation as they get into the bloodstream along with other weird sensations; you can get raised itchy blotches (but these disappear shortly) and bad blood shot eyes accompanied with a bad headache.

They attempted the second one, again with no anaesthetic, but had to abandon it as my foot was so cold due to constricted blood vessels and they couldn't get the needles into my veins without causing me huge amounts of stress. All subsequent ones were carried out in day surgery and done under a general anaesthetic and were so much easier. The thing that I wasn't told when I had them was that initially they can cause more swelling and hence more pain, so several days on I thought they had totally messed up my foot but it did eventually subside.

I'm sorry I'm making this sound awful, but I have had a small amount of improvement after them, mainly in the swelling; this went down quite substantially after the 7th but has unfortunately returned with the cold weather. My pain specialist said that he would do no more of these as I am still unable to walk and have had no major improvements. I am now booked in for a lumbar sympathectomy in March. As I said, this is only my experience, so please don't be put off. I have a friend who had a condition that wasn't diagnosed as RSD ten years ago but sounds identical to mine, and after being wheelchair bound for some time walked after her 2nd block! Please don't let me dishearten you. Although if you do decide to proceed with blocks I would insist on having them under a general anaesthetic if possible as this makes the whole procedure a lot easier and therefore less painful.

I was also told that any benefits would be short lived - several hours at most. What they hope is that in this amount of time the pain signals/nerve impulses would reverse themselves and after several blocks, resolve the situation. RSD is so individual so the things that don't work for one may be miraculous for another and vice versa. Katy - Buckinghamshire, UK

Response to Katy
I am sorry to hear you had such a bad experience with Guanethidine blocks, the next one I have will be on 16th January, and will be number 51. I will admit that they are not always lasting as long or sometimes as well as they first did, but any relief no matter how short lasting is better than none. Your pain specialist must be a little barbaric to say the least as mine has always done them under a General Anaesthetic, she was the one that told be it would be to painful to bear otherwise, due to the RSD. I agree that under no circumstances should one of these block be carried out by a GP. Firstly it is a sterile procedure and secondly it needs to be done by someone who has been trained on this treatment - otherwise so much could be done.

I have been having this treatment over a period of 8 years and normally have about 7 a year. You need to make sure that there is no manipulation whilst you are under as this could also make it worse (see Dr Hooshmond's site, a pain clinic in Florida - you can get into it through the RSD Alert links page - and then look into his puzzle pages and if you have a look down you will soon see it. Kate - Berkshire, UK

Has anyone had a sympathetic nerve block in the foot? I'm not sure of the exact name of the procedure, but they put a cuff at the top of your leg to cut off circulation and inject a drug into the foot, leave it for 20 minutes then let the cuff down. If so, has anyone gone through agony with this? A couple of days of slight pain relief can't be worth the stress and agony of my foot being pulled around and needles stuck into it! I keep saying this to my pain consultant but she just dismisses it and says this is the only thing to do. I've got a feeling she is sticking to some pain plan she always applies, no matter about the feelings or concerns of her patients. Sorry about the diatribe but I'm fed up with beating my head against Doctors walls. I have refused to have any more nerve blocks until I can have a general anaesthetic, but my doctor said I couldn't have a GA because of my low blood pressure. Ari. - UK

I believe the block Ari is describing is called a bier block. It's the one where they cut off the circulation for about 20 minutes to the affected limb, inject the medication, then let the cuff down after about 20 minutes.
The more people that know that the body will still feel pain unless a sympathetic or ganglion block is used when having surgery, the better. Doctors don't seem to understand that we still feel the pain - I woke up 5 times during surgery because a doctor failed to block the area to the arm that he was working on; then he blamed me! Nanette - USA

I've got RSD/CRPS in my right foot and had a series of about 8 Guanethidine Nerve Blocks in the foot several years ago. I was put to sleep for the procedure and - Nanette is right - they put a cuff around top of leg, put a cannula* into the main vein in foot and inject the drug... I was given Medazalm and Alfentinil in theatre to put me asleep and to control the pain. I found that the Guanethidine Blocks made my foot turn very hot (instead of stone cold) and even more swollen. Pain wise they didn't do anything for me. Mel -UK
* Cannula = a tube inserted into the body to withdraw or deliver fluid

I too have had this treatment with the cuff etc except it is for my hands. It helps if they give you a pain relief injection before they start putting the cuff on and injecting the nerve block. However, like Ari, I am not sure whether it is worth it for just a few days of pain relief. By the way, I am going to have my final block (for the moment) this coming Monday. Wish me luck, cause it hurts like hell! Daphne - Pinner, Middlesex, UK

I have had 2 sets of these nerve blocks. After the first set the pain went away for about 2 weeks then returned with a vengeance. I had the second set done with no relief. They were very painful and because all the veins in my foot had collapsed they had a lot of difficulty finding veins. They mostly used the one in my big toe and for the last session they used the one in my instep. The nurse said she was not going to do any more on me as It was too traumatic finding veins. Katie - UK

I stumbled across your site while doing some research and thought I would give a brief description of my experience with nerve blocks in the US.

I have an external retroversion in my right hip since birth, its too small for a rotational osteotomy despite my many request and 8 different surgeons in the New England area. After a cyst in the right knee and two arthoscopic surgeries my latest surgeon had diagnosed me with CRPS 1/RSD.
Two complete years of physical therapy were only able to maintain my strength and we were never able to break through the "glass ceiling" to a normal activity level. The pain would increase and I would dramaticaly lose strength in 3 - 4 days and lose 2 months of progress.
Last November I switched doctors to a private hospital specialising in orthopedics: After 4 months of diagnostic tests including:

• Patella tracking Brace
• Medial compartment unloader brace
• Bone scan
• MRI(2)
• X-Rays (too many to count)

...to make a long story short, the combination of the retroversion and the surgery has caused RSD. My surgeon has forwarded me to his group's pain clinic and I have now received two sympathetic nerve blocks with excellent results. The pain has almost completely subsided and, as the papers
suggest, the blocks are spacing themselves apart. I am just starting to try to rebuild the strength I lost, and hopefully be able to go for a walk with my wife for more than a few blocks.

As a note, my nerve block are almost exactly as described at http://www.spineuniverse.com/displayarticle.php/article1180.html

I hope this helps you or your readers in some way and I wish you the best of luck. Carl Morse - New Hampshire, USA

I am a Forensic Biochemist. From reading my edition of Doctor's Guide I know that they are finding Guanethidine (a drug used for blocks) is not working as well as they first thought it would, particularly in men, but was almost as bad in women under the age of 60. Bupivicaine seems to be one of the more useful drugs used for blocks, as well as in morphine pumps. Bupivicaine seems to be the drug of choice now, as is the super Dilaudid as well as the super morphine. The one problem however in its use in pumps is that it completely obliterates pain, and if you accidentally cut your foot, or are not constantly vigil about your feet it can lead to infection. Do remind folks that when they have blocks they should have them about a week apart, series of 3, then try to go as long as possible, and I'm talking 6 months to a year, before they have another series of blocks, they seem to work better that way. Also, the body doesn't become so used to them. Nanette Sheckler, PhD - USA