Facet Nerve Block (cervical, thoracic, lumbar)
What is a facet nerve block?
A facet nerve block is an injection of a small amount of local anesthetic and steroid at the facet joint in the spine, putting medication around the nerves that supply the facet joint. If your pain is truly coming from these joints, then your pain should improve even temporarily while the numbing medication is effective. This will confirm a diagnosis of facet syndrome or facet mediated pain. The facet nerve block is usually done at more than one level, and it may be done on one side or both sides.
Why would a facet nerve block be performed?
A facet nerve block may be performed if you are experiencing neck pain that is associated with headache and shoulder pain, mid back pain, and low back pain that may go into the hip and thigh areas. Following your evaluation, if facet syndrome is suspected, then this injection will be recommended to confirm the diagnosis. Often, if your pain is improved from this injection, it may be on a temporary basis. If so, a more advanced procedure can be done to provide the same pain improvement on a long-term basis. However, this procedure alone can offer some patients significant pain improvement over the course of several months.
What are the benefits of doing a facet nerve block?
This procedure is critical in confirming the diagnosis of facet syndrome. Also, it can be a therapeutic injection if pain is improved over an extended period of time.
What are reasons NOT to do a facet nerve block?
A facet nerve block will not be performed if you an active infection, fever, recent or pending surgery, bleeding problems, allergy to the local anesthetic and steroid, and/or pregnancy.
What are the preparations for the procedure?
Before the procedure, you are asked NOT to eat for four (4) hours prior and NOT to drink liquids two (2) hours prior to your procedure time. You must have someone of age to drive you home following your procedure, as you will not be permitted to drive a vehicle on the day of your procedure. Anyone who is taking a blood thinning medication such as coumadin will be required to stop that medication for a specified time period before the procedure. Otherwise, you may take your regularly prescribed medications the morning of your procedure with a sip of water. If you are a diabetic patient, you may eat a limited amount before your procedure to avoid hypoglycemia.
What are possible side effects of steroid medication?
Administration of steroid medication can cause side effects. Side effects can include but not limited to hyperglycemia, altered menstrual cycle, fluid retention, bruising, insomnia, sweats, hot/cold flashes, flushing of the face, weight gain, epidural lipomatosis, steroid myopathy, avascular necrosis of bone, osteoporosis, and Cushing’s syndrome.
What will occur during the facet nerve block?
After the procedure and complications have been explained by the physician or physician assistant, an informed consent paper, (giving permission for the procedure), must be signed by the patient. Then, the patient is taken to the procedure room by a staff member. You will then lie down on the x-ray table on your stomach. The area to be injected will be cleaned using an antiseptic solution, which is usually betadine unless you are allergic to this. Numbing medicine will then be injected under the skin to numb the area where the injection will occur. The physician will then guide a needle to the area of the facet joint where the nerve goes into the joint under x-ray. The medicine is then injected after correct needle placement has been confirmed on x-ray. Remember, the needle may not necessarily be placed in exactly the same area as your pain. This procedure may require multiple needles sticks on one or both sides depending on your area of pain.
How long is the procedure?
Usually, the facet nerve block lasts about 15 minutes depending on the area of injection. Keep in mind that the severity of the problem and other factors such as surgery and placement of hardware into the spine may make the procedure more challenging and may take longer to perform.
What happens after the procedure?
After the procedure is completed, the patient is taken to our recovery area. There, you will be monitored closely by checking the blood pressure, heart rate, and pain score level. You may be given something to drink at this time. Also, the staff will be observing for any signs of side effects from the procedure. When ready, you will be given discharge instructions and any follow-up information that is needed. Remember, you may experience numbness in the affected area until the local anesthetic wears off completely. The two most important elements that we are looking for after a facet nerve block are:
- Did your pain get better?
- Was the pain improvement a significant improvement?
What are possible complications from the procedure?
This procedure does come with risks. Complications that can occur include but not limited to dural puncture, spinal cord trauma, infection, intravascular injection, spinal anesthesia, chemical meningitis, neural trauma, pneumothorax, radiation exposure, hematoma formation, and reaction to the steroid medication.
- If you suspect you might be pregnant or know you are pregnant, please notify the physician or any staff member, as this is a reason NOT to do the facet nerve block.
- If you are a diabetic patient taking insulin or pills to manage your diabetes, the steroid used in the facet nerve block can raise your blood sugar level temporarily. You should monitor your blood sugar level closely after your procedure. If your blood sugar level continues to be elevated then contact your primary care physician for suggestions on how to best manage this issue.
- After the procedure, you should resume your regular medications as you are prescribed if those medications were stopped before the injection.
- On the day of the procedure, you should not plan any strenuous activities. Usually, patients are able to resume their regular daily activities on the following day.
* If you do not understand any part of the above material, please discuss it with your physician or physician assistant. *