Nerve Blocks

What is a nerve block? 

The injection of medications near a nerve. Usually a combination of local anesthetic and a corticosteroid are used to reduce inflammation and rapidly improve pain.

What medications do you use?

We use a combination of a local anesthetic (i.e. lidocaine) and cortisone, a corticosteroid.

Why do you use cortisone?

Cortisone (corticosteroid) injections are a method of introducing a powerful anti-inflammatory medicine near nerves or into joints to treat the inflammation that is driving the pain process. As people age, wear and tear on joints, intervertebral discs, bone spurs, and injuries can trigger inflammatory processes and chemical mediators that trigger chronic pain.  Injecting cortisone into the affected joints or nerves can significantly reduce swelling from these processes and lead to improvement in your pain symptoms.

Are corticosteroids (i.e. cortisone) bad for you? 

Yes, excessive corticosteroids are bad. Limited amounts of local corticosteroids used to improve quality of life are acceptable. Continuous oral steroid and intravascular cortisone could cause many side effects, including worsening bone density, dependence, mood changes, hyperglycemia, and skin changes.

Why do we use interventions instead of opiate pain medications?

Opiate medications (i.e. morphine, oxycodone, dilaudid) stimulate various opiate receptors in the body, but they do not treat the underlying inflammatory process. Longterm use of opiates can lead to tolerance, worsening pain, constipation, insomnia, nausea, and dependence. Interventions (i.e. nerve blocks) treat the inflammatory process that leads to debilitating pain.

What type of pain can we perform interventions for?

All kinds of pain can be successfully managed with our interventions.  Medication can be introduced to the epidural space around the spinal cord, near the spinal cord nerve roots, into various joints, into muscles, and more!

Examples of interventions that we perform:

* Lumbar or thoracic or cervical facet joint as well as sacroiliac joint injections: The facet joints are located on the back and side of the bony spinal column on both sides. Spinal injury, age related wear and tear or stress, inflammatory disease, etc. could cause swelling and then arthritic changes into the joints. Cortisone injection into the joints under fluoroscopic guidance relieves swelling and pain. If pain relief does not last following the series of cortisone injections, then deadening of the nerve (denervation) for the joints would be considered to achieve lasting pain relief from the arthritic joint pain.

* Transforaminal approach requires needle placement into the opening (foramen) of the spine where the spinal nerve roots come out. This technique is especially useful when the patient has one sided pain with a high degree of suspicion for particular nerve roots as being causative in the pain complaint in the legs(sciatica) or arms. This technique should be performed with fluoroscopic guidance. Because of the use of fluoroscope and much thinner needle compared to the traditional epidural needle, the tissue trauma and incidence of thecal sac puncture is less in the transfoaminal approach. Besides, this approach delivers medicine closer to the problem site (ruptured or herniated disc) than epidural approach. Because of great efficacy and safety, this approach is being used more and more by pain physicians.

* The Caudal injection technique is used for very low lumbar spine pathology such as L5-S1 disc herniation. The needle is passed into the sacral canal, which is essentially near the tailbone area. The procedure may or may not be performed with fluoroscopy. This procedure is relatively safe because the spinal cord is far from the needle.

Spinal injections are associated with risks and potential complications. With x-ray guidance, and with experienced hands, the complication rate is felt to be lower. This is especially true when a transforaminal approach is utilized. The risks and complications are as follows: increased pain, bleeding, infection, failure to produce desired result, puncture of the spinal sac causing spinal headache, spinal cord injury causing paralysis, infection of the spine (meningitis), and reaction to medications resulting in anaphylactic reaction with a possible heart attack, stroke, or death. The excessive steroid use could cause weight gain, temporary increased blood sugar and blood pressure.

The patient is placed on his / her stomach, fluoroscopy is placed to visualize the spinal elements. The area of the injection is prepared with disinfectant. Local anesthetic is injected for the epidural injection. Under direct fluoroscopy imaging, the needle tip is advanced either into epidural space, foramen (for the transforaminal nerve block) or into the facet or Sacroiliac joint. Then the steroid medication mixed with saline and local anesthetic would be deposited. Contrast dye may be used to confirm the needle tip placement if it is in question.

Patients are closely observed after procedures to ensure no adverse events occur.  When patients have adequately recovered, they are released home with educational materials.