Treatments ~ Nerve Blocks
A nerve block is a treatment used to both treat and diagnose severe pain. The block is placed by injecting a substance like alcohol or phenol into or around the nerve to numb it and interrupt the pain signals sent to the brain.
A therapeutic nerve block is used to treat pain and often contains a local anesthetic that will relieve pain. Nerve blocks used to treat chronic pain can work for up to 6-12 months and can be repeated as needed. They can be helpful to cancer patients. Diagnostic nerve blocks insert an anesthetic for a certain amount of time to determine the source of the pain.
However, nerve blocks can cause serious side effects such as paralysis and damage to arteries. They can also cause low blood pressure, puncturing of the lung or damage to the kidney. Some newer blocks use extreme heat or cold instead of a chemical to prevent some of these side effects. Nerve blocks are sometimes used to avoid surgical procedures, but are not always the answer.
Intercostal Nerve Block
The intercostal nerves are located underneath the lower edge of each rib. An intercostal nerve block is an injection to relieve pain originating from the intercostal nerves. The injection itself only takes a few minutes, although patients should expect to remain at our office for about an hour; this includes consulting with your doctor before the procedure and recovery room observation afterwards.
Intercostal Nerve Block Procedure
An intercostal nerve block can be performed with only a local anesthetic, although sedation is an option for anxious patients. During the procedure, you will be lying down on your stomach. Once the local anesthetic has taken effect, the skin surrounding the affected rib(s) will be cleaned. With the assistance of x-ray and contrast dye, a needle is inserted under the rib. Once the needle is situated properly, the medicine is injected.
After Intercostal Nerve Block
Patients return home the same day as their intercostal nerve block, and most patients can return to work the same day or the next day. Your doctor will provide you with specific instructions pertaining to your individual condition.
Effectiveness of Intercostal Nerve Block
The exact effectiveness of an intercostal nerve block varies from patient to patient. Typically, patients whose pain has begun recently are more likely to experience relief from this procedure than patients who have been in pain for a longer period of time. If the initial injection relieves your pain for a reasonable amount of time, you may qualify for an additional intercostal nerve block. Your doctor will monitor your progress and determine whether another injection is right for you.
Risks Associated With Intercostal Nerve Block
While an intercostal nerve block is a safe procedure, most procedures carry a slight risk of complications. Although they rarely occur, these risks may include worsened pain after the injection, infection, nerve damage, bleeding, accidental puncture of the sack containing spinal fluid, or a collapsed lung. You can further minimize the occurrence of complications by choosing a qualified doctor for your procedure.
Lumbar Selective Nerve Root Block
The epidural space surrounds the protective covering of the spinal cord and its nerves. A lumbar selective nerve root block is a minimally-invasive procedure for treating leg and lower back pain. This procedure injects medication directly into the affected nerve root.
Lumbar Selective Nerve Root Block
A lumbar selective nerve root block is performed with local anesthetic, although sedation is also an option. After the local anesthetic has numbed your skin, your doctor will use an imaging technique known as fluoroscopy to insert a small needle into the epidural space. Once the needle is properly situated, an anesthetic and steroid will be injected directly into the affected nerve root.
After Lumbar Selective Nerve Root Block
After your lumbar selective nerve root block, you will be observed in our recovery area for about 30 minutes. Patients return home the same day as their procedure, and most patients return to work the very next day. You may experience immediate pain relief for a few hours after the injection that then worsens for a few days; this is normal, and may be caused by irritation from the needle. The steroids used for this injection usually take about a week to fully relieve pain.
Effectiveness of Lumbar Selective Nerve Root Block
The effectiveness of a lumbar selective nerve root block varies. Some patients experience long-term, or sometimes even permanent, pain relief after one injection, requiring no further treatment. Others may require additional treatment a few weeks or months later. The exact effectiveness of a lumbar selective nerve root block depends on your individual condition.
Lumbar Sympathetic Nerve Block
A lumbar sympathetic nerve block is administered to both diagnose and treat pain in the lumbar (lower) region of the spine. It is used to determine whether the lumbar sympathetic nerves, which carry pain impulses from the lower extremities, are the cause of the pain, and, in some cases, serves to eliminate that pain altogether. During the procedure, medication is injected into or around the lumbar sympathetic nerves on one side of the body.
Underlying conditions for which a lumbar sympathetic block may be considered include the following:
- Complex regional pain syndrome
- Herpes zoster (shingles)
- Peripheral vascular disease
When successful, the injections reduce pain, inflammation, abnormal skin color and sweating, and improve the patient's mobility.
Lumbar Sympathetic Nerve Block Procedure
Receiving a lumbar sympathetic nerve block injection takes only a few minutes, although the patient will likely spend a few hours in an outpatient surgical setting or doctor's office. These hours include the time needed for preparation, positioning and recovery. During the procedure, the patient lies facedown, and a local anesthetic is administered. In most cases, patients are also sedated to minimize anxiety. Once the local anesthetic has numbed the skin, the injection is administered.
The injection contains an anesthetic to numb the inflamed area. Sometimes it also contains a corticosteroid to reduce inflammation, or clonidine, a hypotensive agent. These medications are added to provide long-lasting pain relief. Immediately after receiving an injection, a patient may experience warmth in the leg, but the sensation disappears quickly.
Risks of a Lumbar Sympathetic Nerve Block
Although receiving a lumbar sympathetic nerve block is a safe, there is a risk of complications, which includes infection at the injection site, nerve damage, bleeding, or leakage of spinal fluid.
Recovery from a Lumbar Sympathetic Nerve Block
After a lumbar sympathetic nerve block procedure, a patient usually returns home after a few hours, and is able to return to work the next day. The effectiveness of a lumbar sympathetic nerve block varies. Some patients experience permanent relief, whereas others experience relief for only a few weeks or months, and require additional treatment.
If the block relieves the patient's pain, a series of injections may be administered to provide long-lasting relief. If the block does not relieve pain, radiofrequency ablation may be considered.