Nerve Block Therapy

www.drjudylee.com

What is nerve block therapy?
Nerve block therapy is the term used to refer to a variety of outpatient surgical procedures which are intended for the relief of pain caused by bulging discs, bone spurs, nerve root compression, scar tissue and other conditions.  These procedures involve an injection directly into the area of pain.

How does it work?
In most cases a combination of a local anesthetic and a cortisone drug (steroid) are injected into the area which is the root of the pain.  Steroids are powerful anti-inflammatory medications which can act to reduce swelling and irritation in and around the affected nerve, thus alleviating the pain.

What are the different types of nerve block therapies?

Peripheral Nerve Block:
Involves injection of local anesthetics/steroid mixture into the painful areas (ie: peripheral nerves, trigger points, bursitis, tendonitis)

Central Nerve Block:
All central nerve blocks are performed under fluoroscopic guidance. (Examples Listed)

  1. Epidural Steroid Injections – ESI’s involve injection of the steroid/anesthetic mixture into the space around the spinal cord, which is called the epidural space.
  2. Sympathetic Nerve Blocks - This is an injection of anesthetic into the sympathetic chain to alleviate sympathetic pain in the head, neck, abdomen/pelvic and upper extremities.
  3. Transforaminal Epidural Injections - The spinal nerve suspected to be the cause of the pain are located, and a steroid injection is given.
  4. Facet Joint Injections - Injection of steriod is given directly into the facet joint with the intention of reducing inflammation.
  5. Lysis of Epidural Adhesions w/Racz - Special Racz needle and catheter are used to break up epidural adhesions (scar tissue) and inject steroid into the epidural space.
www.drjudylee.comWhen will it start working?

Some patients feel immediate relief after a nerve block therapy.  Most patients, however, report two or three days before they feel maximum relief.  A significantly fewer number of patients feel relief in as long as a week or two.

How many treatments will I need?
If response is positive following the initial injection a series of infections may be suggested.  Most commonly three procedures will be advised within a 1-2 months for maximum relief.

Are there side effects or complications?
Yes, including infection, bleeding, nerve damage, temporary increase in blood sugar, blood pressure, water retension, or allergic reaction to x-ray dye, Etc.
It is common to feel increased back discomfort especially in the area of the injection for 24-48 hours.  Spinal headache is another possible side effect, occurring in less than 1% of cases.  Should headache occur contact us.  Dr. Lee may consider blood patch to treat the headache.

Does it hurt?
Before you are given the injection, local anesthetic is placed on to the skin the area of the injection.  The actual placement of the needle should cause only a sensation of pressure.  Within a few minutes some patients feel a warmth or numbness in their extremities from the anesthetics.  This will last up to one hour.

Does it work for everyone?
No. Approximately two thirds of patients without prior back surgery will obtain some relief from nerve block therapy.  Occasionally the response is so dramatic that only one or two injections are needed.

Should I try it only as a last resort?

No. It should be considered before resorting to more invasive procedures.  If nerve blocks are not successful then drugs and other modalities including surgery will be considered.

Is it covered by health insurance?
Yes. While degrees of coverage differ from plan to plan, all plans do provide coverage for nerve block therapies.  Please check with your insurance carrier to be sure adequate coverage is provided for the procedure suggested by the physician.  Auto insurance and workman’s compensation requires pre-authorization.  All such authorization must be completed prior to the scheduling of a procedure.

Where will the procedure take place?
Dr. Lee performs nerve block therapies at her clinicin Okemos, MI.  That facility is equipped with a c-arm fluoroscope which allows your procedure to be performed more safely and accurately.  On the day of your procedure please arrive 30 min prior to the scheduled time.  You will be observed in our recovery area for 30 min. after your procedure.

Do I need to make any special preparations prior to my procedure?
Yes, Dr. Lee has developed the following guidelines for all nerve block therapies.
  1. You should not eat solids or drink anything for 8 hours prior to your procedure.
  2. If you plan to be sedated by IV you must be accompanied by a responsible driver for 24 hours following the procedure.
  3. If you take blood thinners, are diabetic, pregnant, have ongoing infection or feel ill you must tell the doctor ahead of time so appropriate precautions can be taken.