Overview Of The Nerve Root Injection Procedure
Heres what to expect during a lumbar nerve root injection procedure:
- You will lie face down, with a pillow underneath your abdomen.
- The injection area is cleaned and numbed before the injection.
- Using fluoroscopic guidance, your physician will determine the appropriate path for the needle.
- Your doctor will insert a thin needle to a point immediately behind the nerve root.
- Next, your doctor will inject a small amount of contrast dye to make sure that the medication will flow exactly where intended.
- Then, your physician will inject a small amount of anesthetic, steroid, or a combination of both, depending on the procedures purpose.
- During the injection, you may feel a sensation of pressure in the neck or arm. This typically disappears in a few moments.
- After the procedure, youll spend 20 to 30 minutes in the recovery area.
Can Anyone Have A Nerve Block
If you are going to have surgery, talk to your surgeon or anesthesiologist beforehand to ask if you are eligible for a nerve block. You may not be eligible for one if you have an infection at the site where the injection would be made, if you have a bleeding disorder, if you are taking an anticoagulant that you have not stopped ahead of time, or if you have had problems with the nerve in the area that would be targeted by the injection.
How Long Does The Pain Relief Last
The full pain-relieving effects of the steroids can take several days to take effect.
The amount of time that an occipital nerve block reduces pain varies from person to person. However, they can cause pain relief for months in some people.
An occipital nerve block is used to reduce chronic head pain.
Some of the specific conditions its commonly used to treat include the following.
- Migraines.Migraines are a neurological condition that usually causes intense headaches on one side of the head. People who have migraines commonly also experience nausea, dizziness, and mood changes.
- Cluster headaches. Cluster headaches are a short but painful series of reoccurring headaches. People who experience them tend to get them seasonally.
- Spondylosis of the cervical facet joints. Also called osteoarthritis of the joints in your neck, spondylosis of the cervical facet joints is often caused by the age-related breakdown of your neck bones and discs.
- Occipital neuralgia. Occipital neuralgia is a headache disorder that usually causes
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What Happens After Treatment
Most patients can walk around immediately after the procedure. After being monitored for a short time, you can usually leave the office or suite. Someone must drive you home.
Typically patients resume full activity the next day. Soreness around the injection site may be relieved by using ice and taking a mild analgesic .
You may be asked to perform activities that normally cause pain to determine if the procedure was effective. You may want to record your levels of pain during the next couple of hours ina diary. You may notice a slight increase in pain as the numbing medicine wears off.
Q10 Typically How Long Do The Effects Of Injection Treatment Last
It is difficult to predict how long an injection will last given the many variables at playsuch as the type of injection, type of pathology , and/or how long symptoms last. Most people can expect to receive 1.5 to 3 months of pain relief. In some cases, an injection may provide minimal or only a few days of pain relief, while other patients may see symptom improvement up to a year after receiving an injection.
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What Is A Nerve Block
A nerve block is an anesthetic and/or anti-inflammatory injection targeted toward a certain nerve or group of nerves to treat pain. The purpose of the injection is to “turn off” a pain signal coming from a specific location in the body or to decrease inflammation in that area.
Your doctor may use imaging guidance, such as ultrasound, fluoroscopy, or computed tomography , to help place the needle in the most appropriate location. This will allow you to receive the maximum benefit from the injection.
Who Interprets The Results And How Do I Get Them
A radiologist or other pain management doctor will most likely perform the nerve block injection.
The doctor who delivers the injections will follow up with you to see how you are doing and determine if further action is required. Any imaging that is performed during the procedure itself will conclude with the procedure, and no follow-up image interpretation is necessary.
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Your Injection Frequency Depends On Your Medical History
Based on your medical history and physician preferences, injections can be repeated. Your health care provider will determine the exact number of injections that you can receive. Medical conditions, such as diabetes, will mean that may receive your injections less frequently.
Ultimately, Dr. Shin says, the goal of nerve block injections is to decrease pain, increase your function by participating in physical therapy and, for some patients, avoid surgery.
How Is The Procedure Performed
This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Ask your doctor if you will need to be admitted.
Nerve blocks usually take only minutes to administer.
You will lie on a table or other surface to allow the doctor access to the site to be injected. The doctor will identify the spot where the needle needs to be placed, using palpation and/or imaging guidance. They will clean the area with antiseptic solution. They will insert the needle at a specific depth to deliver the medication as close to the problematic nerve as possible. The doctor may use an injection of contrast material to confirm needle position prior to injecting the medicine.
You may need more than one injection. This will depend on how many areas of pain you have or how large an area is involved. The doctor will most likely tell you when they insert the needle and when the injection is done.
When finished, you will be allowed to rest for 15 to 30 minutes to let the medication take effect. The nurse will also make sure you don’t have any unexpected side effects before you leave the doctor’s office.
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Who Should Not Have This Injection
The following patients should not have this injection: if you are allergic to any of the medications to be injected, if you are on a blood-thinning medication , or if you have an active infection going on. With blood thinners like Coumadin, your doctor may advise you to stop this for 4-7 days beforehand or take bridge therapy with Lovenox prior to the procedures. Anti-platelet drugs like Plavix may have to be stopped for 5-10 days prior to the procedure.
Can A Nerve Block Be Permanent
Most surgical nerve blocks can be considered permanent. But they are often reserved for rare cases of chronic pain when no other treatments have been successful, such as cancer pain or chronic regional pain syndrome.
In a permanent nerve block, the nerve itself is completely destroyed either by deliberating cutting the nerve, removing it, or damaging it with small electrical currents, alcohol, phenol, or cryogenic freezing.
However, not all permanent nerve destruction procedures actually end up being permanent. They may only end up lasting a few months because the nerve can regrow or repair itself. When the nerve grows back, the pain may return, but its also possible that it wont.
Nerve blocks are very safe, but like any medical procedure, a nerve block carries some risks. In general, nerve blocks carry fewer side effects than most other types of pain medications.
Risks and side effects of a nerve block include:
- injection site tenderness
- blocking the wrong nerve
- Horners syndrome, which causes drooping eyelid and decreased pupil size when the nerve between the brain and the eye is affected
- damage to nerves
The area that has been blocked may remain numb or weak for up to 24 hours. During this time, you probably wont be able to tell if something is painful. Youll have to be careful not to place hot or very cold things on the area or to bump, injure, or cut off circulation to the affected area.
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How Is A Nerve Block Administered
The anesthesiologist will perform a nerve block before you go into the operating room. Often, she will give you a mild sedative first to relieve any anxiety and help you relax. Next, she will insert a hair-thin needlethe size of an acupuncture needleand inject medication into the surgical site in an area around the nerve. The anesthesiologist will watch the progress of the needle on a monitor, using real-time ultrasound guidance to make sure the pain relief medication is delivered with precision.
With a nerve block, the idea is to only send medication around the nerve so that the nerve can absorb it. Its important to avoid making an injection directly into it, which can cause serious side effects including limb numbness or weakness. The anesthesiologist may choose from a variety of numbing medications, including lidocaine, which is also used as a numbing agent for dental procedures.
A nerve block typically takes less than 10 minutes to administer and up to 30 minutes to take full effect.
How Often Should An Esi Be Offered
Up to three injections may be given within a six-month time frame. Usually, the injections are performed two to three weeks apart. A set of three injections is normally offered. However, you may gain considerable relief after the first or second injection. In that instance, further injections may not be necessary.
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How Should I Prepare For The Procedure
Usually, a nerve block requires no special preparation.
You may need to change into a gown for the procedure.
The doctor will probably ask you to use the restroom before the procedure.
You lie on your stomach, back or side on a special fluoroscopic or CT table. This will give the doctor easiest access to the injection site. The nurse or technologist will help to make you as comfortable as possible, both during and after the procedure.
What Will I Experience During The Procedure
You will probably feel a “pinch” when the doctor inserts the needle. However, as soon as the injection delivers the medication, you should feel less discomfort. Sometimes the doctor must insert the needle deep to reach the nerve causing your problem. This can be temporarily uncomfortable, but it is important to hold still so that the doctor can correctly insert the needle.
If you require an injection close to a major nerve or bundle of nerves, such as the sciatic nerve, your doctor will tell you to speak up if you get a sudden jolt of pain. This means that the needle has come too close to the major nerve and will need to be retracted and re-positioned. This happens rarely, however, so it should not be a major concern.
After the injection, you will probably experience a sensation of pain relief in the area injected. This will typically last up to one or two weeks, or even permanently in some cases.
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What Will The Nerve Block Feel Like
If your anesthesiologist gives you mild sedation, it may make you drowsy and relaxed. The nerve block injection itself should cause minimal pain, if any. Otherwise, for certain procedures such as hand surgery, you should be able to remain awake and aware of your surroundings and free to communicate with your caregivers during surgery, if desired. This is different from general anesthesia, which would make you unconscious, and could lead to some lingering confusion and cognitive dysfunction when you wake up, especially if you are an older adult.
Once your surgery is over, you may feel some heaviness or numbness from the nerve block. Its important to talk to your caregivers before you stand up and move aroundor put any pressure at all on your bodybecause the nerve block may continue to affect your muscle control and balance for a while.
Benefits Of Nerve Blocks
Nerve blocks can be used to manage chronic, or long-term, pain, pain after surgery, severe acute, or short-term, pain. Nerve blocks ease pain by offering immediate relief. They can also offer longer-term relief, because some injections reduce irritation to the nerves and let them heal.
Nerve blocks can help people who have chronic pain function better in their daily lives, allowing them to go to work, exercise, and do daily tasks.
Temporary nerve blocks are often a short-term fix. The pain may return within as little as a few hours after the drugs wear off. Some people may need repeated or even long-term nerve block treatments to manage inflammation and pain.
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What Is An Esi
An ESI is the injection of pain-relief and anti-inflammation medications into the epidural space.
The epidural space is an area that surrounds the spinal cord. It contains the large spinal nerves that are responsible for pain sensations in the neck and back.
During an ESI, your pain specialist will inject corticosteroid medication into the epidural space. This reduces swelling around the spinal nerves and relieves pressure and pain in the neck and back areas.
In most cases, your pain specialist will also add a fast-acting anesthetic such as lidocaine or bupivacaine, to the ESI. This numbing medication offers immediate pain relief and may help your pain specialist find the reason for your neck/back pain.
Medial Branch Block Results
Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the medial branch nerves targeted are the ones carrying signals for their pain. If the joint or joints being targeted are not causing the pain, a patient will not obtain relief from the medial branch nerve block.
The patient will discuss with the doctor any immediate pain relief. Ideally, patients will also record the levels of pain relief during the next several hours in a pain diary. A pain diary is helpful to clearly inform the treating physician of the injection results and in planning future tests and/or treatment, as needed.
Patients may continue to take their regular medications after the procedure, with the exception of limiting pain medicine within the first 4 to 6 hours after the injection so that the diagnostic information obtained is accurate.
On occasion, patients may feel numb or have a slightly weak or odd feeling in their neck or back for a few hours after the injection.
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Types Of Nerve Blocks
A local nerve block is performed by injecting or applying local anesthetics, such as lidocaine, to a certain area. An epidural is a local nerve block that involves injecting steroids or analgesics into the area that surrounds the spinal cord.
Though common during childbirth, an epidural may be also be used to treat chronic neck or back pain caused by a compressed spinal nerve. Local nerve blocks are usually temporary, although some may be repeated over time.
A neurolytic block uses alcohol, phenol, or thermal agents, such as cryogenic freezing, to treat chronic nerve pain. These procedures actually cause damage to certain areas of the nerve pathway. This means a neurolytic block is usually appropriate only in severe chronic pain cases, such as cancer pain or complex regional pain syndrome .
A surgical nerve block is performed by a neurosurgeon and involves surgically removing or selectively damaging certain areas of the nerve. Like a neurolytic block, a surgical nerve block is usually reserved for severe pain cases, such as cancer pain or trigeminal neuralgia. Most surgical nerve blocks are permanent.
What Are Some Common Uses Of The Procedure
People who suffer from either acute or chronic pain might have a nerve block injection to achieve temporary pain relief. Often, such pain originates from the spine, but other areas commonly affected include the neck, buttocks, legs, and arms. Delivering a nerve block injection allows a damaged nerve time to heal itself from a state of constant irritation. Additionally, nerve blocks can provide diagnostic information to the doctor. By performing a nerve block and then monitoring how you respond, your doctor may determine the cause or source of the pain and plan further treatment.
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How Are Nerve Blocks Used
There are different kinds of nerve blocks used for various purposes.
- Therapeutic nerve blocks are used to treat painful conditions. Such nerve blocks contain local anesthetic that can be used to control acute pain.
- Diagnostic nerve blocks are used to determine sources of pain. These blocks typically contain an anesthetic with a known duration of relief.
- Prognostic nerve blocks predict the outcomes of given treatments. For example, a nerve block may be performed to determine if more permanent treatments would be successful in treating pain.
- Preemptive nerve blocks are meant to prevent subsequent pain from a procedure that can cause problems including phantom limb pain.
- Nerve blocks can be used, in some cases, to avoid surgery.
What To Expect After A Nerve Root Block
Patients often feel slightly apprehensive about having a nerve root block, because they are slightly worried about the pain levels and are also apprehensive about whether or not it will be successful.
However, there is no need to feel concerned, most root blacks are successful and your pain consultant will have been relatively certain that it will provide some pain relief for you. It is also a really quick procedure, lasting for half an hour or so and it is minimally invasive.
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