What is a Facet Block?
What are the medial branch nerves and why are medial branch blocks helpful?
Medial branch nerves are the very small nerve branches that communicate pain caused by the facet joints in the spine. These nerves do not control any muscles or sensation in the arms or legs. They are located along a bony groove in the low back and neck and over a bone in the mid back. If this procedure has been scheduled, there is strong evidence to suspect that the facet joints are the source of your pain. Therefore, benefit may be obtained from having these medial branch nerves blocked with an anesthetic to see if a more permanent way of blocking these nerves would provide pain relief long term. Blocking these medial branch nerves temporarily stops the transmission of pain signals from the joints to the brain.
What happens during the procedure?
An IV may be started, to provide relaxation medication. You will be placed on the X-ray table and positioned in such a way that the physician can best visualize the bony areas where the medial branch nerves pass, using X-ray guidance. The skin is scrubbed with a cleaning solution. Next, the physician numbs a small area of skin with numbing medicine. This medicine stings for several seconds. After the numbing medicine has been given time to be effective, the physician directs a very small needle, using X-ray guidance near the specific nerve being tested. A small amount of contrast (dye) is injected to ensure proper needle position. Then, a small mixture of numbing medicine (anesthetic) is injected. This usually does not provoke your usual pain. The injection will be repeated at several (usually 3-4) levels.
What happens after the procedure?
You will be observed in the recovery room for 30 – 60 minutes. There is unlikely to be much discomfort. You should start feeling some relief in about 24 – 72 hours. Keep track of the amount of pain relief and duration. If successful you may be a candidate for radiofrequency lesioning (RFR). You will be scheduled to follow up with your physician in the Pain Clinic in 1 – 2 weeks to discuss results of the procedure. You will not be able to drive the day of your procedure. The arm(s), chest wall, or leg(s) may feel weak or numb for a few hours.
General Pre/Post Instructions
You should have nothing to eat for seven hours prior to your procedure. Clear liquids can be taken up to four hours prior to your procedure. Please take your routine medications (i.e. high blood pressure and diabetic medications) with a sip of water at your usual time. If you are on Coumadin, Heparin, Plavix, or any other blood thinners you must notify the office so the timing of these medications can be explained. For your own safety, if you do not follow the above instructions your procedure may be cancelled. A driver must accompany you and be responsible for getting you home. No driving is allowed the day of the procedure. You may return to your normal activities the day after the procedure, including returning to work.