What is a medial branch nerve block?
Medial branch nerves carry pain signals from the spine’s facet joints to the brain. The facet joint is a common source of back or neck pain, particularly in patients over the age of 50. A medial branch nerve block involves injecting an anesthetic near small medial nerves connected to a specific facet joint. Typically, a procedure injects several levels of the spine at once. By interrupting the nerves’ ability to transmit signals to the brain, the procedure determines if the facet joints are the source of your pain. These medial branch nerves do not control any major muscles or carry any sensation in the arms or legs, so there is no danger of negatively affecting those areas. If you experience immediate relief after the injection, then you will likely be a candidate for a procedure with long-term benefits called a radiofrequency ablation.
How is the procedure performed?
The most common nerves targeted with this procedure are the cervical, thoracic, or lumbosacral nerve roots. The levels targeted for your specific injection are identified after a thorough physical examination and review of imaging studies. The procedure is done with the administration of local anesthetic to numb the injection site and is done with the guidance of a fluoroscope so that the needle is placed in the exact location necessary.
What conditions are treated with a medial branch nerve block?
The conditions most commonly treated with a medial branch nerve block include failed back surgery syndrome, spondylosis, lumbago, cervicalgia, and scoliosis.
How Should I prepare for the injection?
If you need something to help with anxiety related to the procedure, you should discuss this with Dr. Irwin. Receiving a pre-procedure medication can help reduce the anxiety. If you are taking any blood pressure medication, you should not skip any regular dose of this medication. However, if you are taking any medications that might thin your blood, you should discuss this with Dr. Irwin to make sure we have approval from your Cardiologist to hold this medication for the appropriate number of days prior to the injection.
On the day of your injection, you should have nothing to eat or drink for two hours prior to the injection. You should have someone who can drive you home from the procedure. You should not return to work the day of your procedure. You can safely resume your normal activity the day after your injection.
What should I expect after my injection?
The local anesthetic might start helping the day of the injection, and we will send you home with a pain diary to document your pain over the next 24 hours. We track whether the pain goes away and if you are better able to tolerate the activities that cause your pain. If you experience relief of more than 50% of your pain, then we discuss your candidacy for radiofrequency ablation.
How often should I have the injection repeated?
The medial branch nerve block is usually a diagnostic procedure. We only expect you to feel pain relief for a couple of days at the most. Some patients benefit from a second injection, but the goal is to find a treatment with more permanent benefits.
Are there things I should look for after having this procedure?
Of course, you can call our office with any questions you might have. There are certain “red flag” warnings that you should call us about, or if it is after clinic hours you should go to your nearest ER. These would include severe or worsening pain, fever over 101, new or worsening weakness, injection site redness or drainage.