Chemical sympathectomy injection

What is a chemical sympathectomy?

A chemical sympathectomy is an injection on to the sympathetic nerves which run down the front of the spine, close to, but outside the spinal column.

This particular group of nerves, called the sympathetic nerves, can sometimes give rise to pain in the limbs, and often other sensations (such as feeling cold, clammy and changes in colour) can also occur. These nerves also control the blood supply to the limbs.

What is injected?

A small amount of local anaesthetic, with or without steroid is injected into one or more of the sympathetic nerves (painful area). The steroid acts only around the area it is injected into and does not have the same sideeffects as taking long-term steroids.

Where is the procedure done?

The procedure is carried out in either a day case clinical area or in an outpatient area. An appointment will be sent to you by the pain clinic secretaries stating the location for the injection.

On arrival

• You may be asked to put on a hospital gown.
• You will be asked to lie on an X-ray trolley.
• X-rays images (pictures) may be used to guide the needle.
• The area to be injected will be cleaned with antiseptic.
• The consultant will numb the area with local anaesthetic, if needed, before injecting the anaesthetic and steroid.
• You may feel some discomfort during the procedure. This is a good sign, as it helps the consultant to know that the needle is exactly where it is needed.

How long will I be in hospital?

Although the procedure itself only takes about 10 to 15 minutes, you may be on Chedworth Suite for a couple of hours, so please come prepared for this. After the procedure, you will be offered a drink and allowed home shortly afterwards.

Can I take my usual medication?

Continue to take your medication as usual on the treatment day. If you are diabetic and your blood sugar is above 15mmol/l on the day of your procedure you may not be able to have your injection, this will be decided by your consultant. If your blood sugars are above 15mmol/l leading up to your injection please contact the Pain Consultant Office for advice.

Patients taking anticoagulants (blood thinning drugs) such as warfarin or clopidogrel, will be given individual information. Please telephone the Pain Consultant Office if you need advice. It would be useful if you bring a list of your medications with you.

Can I eat and drink?

Please do not have any food for 6 hours before your appointment time. You can have clear fluids up to 2 hours before your appointment.

For example: If you have a morning appointment at 8:30am, do not have any food, sweets or chewing gum after 2:30am. Drink clear fluids, water, black tea or coffee up until 6:30am.

If you have an afternoon appointment at 1:00pm, do not have any food, sweets or chewing gum after 7:00am. Drink clear fluids, water, black tea or coffee up until 11:00am.

Can I drive home?

For safety reasons you are asked not to drive yourself home. You should also have somebody with you for the rest of the day.

Risks

Infection

There is a risk of infection at the injection site, but this is rare due to the use of sterile techniques.

Bleeding

Damage to the small veins on insertion of the needle. Bleeding causing local bruising or bleeding around the nerve.

Allergic reaction

An allergic reaction to injected steroid and local anaesthetic is incredibly rare. However, you must inform us of any know allergic beforehand.

Temporary weakness and numbness in the limb or area that was treated

If this was safe to do so you may have discharged home with these symptoms. Please take care to protect the area or limb until normal sensation returns. This will help to prevent accidental injuries.

Injection site discomfort

Following the injection, you may have some soreness at the injection site, for which you can take some simple painkillers, and it should settle over a few days.

Side effects from the injected steroid

There are very few side effects when steroids are administered this way. Occasionally patients may notice some facial flushing, nausea, or mild abdominal cramps for a few days following the injection.

Menstrual cycle

There can also be a temporary disturbance to the menstrual cycle.

Blood sugar

You may find that the steroid alters your blood sugar control for a few days. Please monitor it closely.

There are no serious complications to this procedure, but if problems arise, please consult your GP who will contact the Pain Clinic if necessary

What happens next?

About 6 weeks after your procedure, you will either be asked to telephone our medical secretaries to give a progress report, or your pain consultant will give you a form to post back to us.

For each option, the next step in your treatment will be decided according to the amount of benefit you have had from the injections. If your pain has improved significantly, you will not need a routine follow up appointment.

Instead, you will be given a patient initiated follow up which is valid for a year, unless otherwise stated. During this time, you can contact us should the same pain become difficult to manage again. Unfortunately, you cannot request a further appointment to discuss any pain that we have not already assessed.

Contact information

For injection treatment follow up or any queries please contact the Pain Consultant Office.

Pain Consultant Office

Tel: 0300 422 3383 / 0300 422 2804

Monday to Friday between 8:00am and 4:00pm.

To rearrange an outpatient appointment, contact the Booking Office.

Outpatient Booking Office

Tel: 0300 422 5327

An answerphone will be in operation at all times, please leave a message and we will return your call as soon as possible.

Further information

For more information about the Gloucestershire Hospitals Pain Management Service please visit the website below:

www.gloshospitals.nhs.uk/our-services/services-weoffer/pain-management-service/about/