Medial Branch Block

  • Reference Number: HEY-577/2017
  • Departments: Pain Medicine

Introduction

This leaflet has been produced to give you general information about your treatment.  This leaflet should have answered most of your questions.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.  If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a medial branch block?

Medial branch nerves are very small nerves that carry the pain message from the joints of the back called the facet joints.

A medial branch block involves injection of local anaesthetic with or without steroids into the space just outside the affected joint close to the nerves that supply the joint. The “blocked” or numbed nerves will not be able to transfer the pain sensation from the joints to the brain.

Why do I need a medial branch block?

A medial branch block is done to relieve back pain, which is thought to be coming from the nerves supplying the facet joint.

Can there be any complications or risks?

Some patients experience mild local tenderness at the site of the injection. This usually settles over the next few days following the injection.  Very rarely, the local anaesthetic may spread causing some numbness in your legs and other areas. This is temporary and will resolve.  There is also a small risk of allergic reaction to the contrast (X-ray dye) used.

The steroid drug used in the injection can occasionally cause such problems as diarrhoea and abdominal pain; this will resolve after a short period of time, however if it continues consult your GP. The steroid can also cause flushing and redness to the face, which also will pass after a short period of time.

How do I prepare for the procedure?

The following information has been produced to ensure that you are able to have your pain relief procedure. It is essential that you read and follow the advice given below before you come to the hospital. If you do not follow the advice you may not be able to have your treatment.

Please contact the Pain Clinic if any of the following apply to you:

  • You are diabetic and take medication to control your diabetes. (See below on how to manage treatment sessions booked for the morning or the afternoon.)
  • You have recently had an admission to hospital.
  • You have tested positive for Meticillin Resistant Staphylococcus Aureus (MRSA).
  • You have an infection and are currently taking antibiotics.
  • You think you may be pregnant.

Continue your other regular medications including your pain relief medication. However, if you take any of the anticoagulants listed below, please notify the Pain Clinic at least 10 days before your appointment. You will need to stop taking these drugs at least 1 week prior to the procedure unless your doctor has advised against this.

  • Warfarin (Marevan).
  • Clopidogrel (Plavix).
  • Dipyridamole (Persantin Retard).
  • Phenindione.
  • Pradaxa.
  • Xarelto.
  • Sinthrome.
  • Asasantin Retard.

You may have to wait a while before your procedure, so please bring something to read or do to keep yourself occupied.  Please leave any valuables or jewellery at home.

It is essential that after the procedure you arrange for an adult friend or relative to collect you by car or taxi. You will not be able to use the bus or train to travel home.  Hospital transport may be available if there is a medical need. If you think you may be eligible please contact your GP surgery.

Sometimes medial branch blocks are done under sedation (a drug is given to make you drowsy and relaxed but still conscious). You should not have anything to eat on the morning of your treatment, however you may have a drink (tea or coffee without milk) if you wish up to two hours before your appointment time.

Advice for diabetic patients only

If you are diabetic and booked to attend treatment in the morning, you should not have breakfast or morning medication but bring the drugs with you.

If you are booked for treatment in the afternoon please have your breakfast and take regular medications before 7.00am. Thereafter, only drink water for up to two hours before the procedure. Please inform the clinic staff as soon as you arrive that you are diabetic, the staff will then assess your diabetes and if necessary take appropriate action to monitor and control your blood sugar while you are in our care.

What will happen?

You will be admitted by the nursing staff who will ask for and record some information about you. Your blood pressure will be checked and you will be given a gown to put on. The doctor will explain the procedure and ask you to sign a consent form. Please make sure you have understood what has been said and feel free to ask any questions.

As a precautionary measure, a thin plastic tube (cannula) may be inserted into a vein in your arm/hand.  After cleaning your back with antiseptic solution, local anaesthetic will be injected into your skin to numb it. Under X-ray screening, a fine needle is introduced into your back towards the area to be treated. A small dose of contrast (X-ray dye) will be used to confirm the exact location of the needle. Once the optimal position is obtained, local anaesthetic with or without steroid will be injected close to the medial branch nerve. The number of injections will depend upon the number of affected joints.

What happens afterwards?

You will be taken on the trolley to the recovery area where the nurse will check your blood pressure and pulse. You will be asked to rest for about an hour. After that you will be able to get up, but please check with the nurse before you do so. Once you are mobile, you will able to go home.

Please ensure that you have arranged for someone to accompany you home after this procedure. Failure to do so will result in your procedure being cancelled. If you have had sedation, we recommend that you arrange for someone to stay with you overnight and that you do not drive for 24 hours.

Take it gently for a few days but gradually build up your activities. You should continue to take all your usual medication/pain medication as the pain may be slightly worse until the medial branch block starts to work.

Some people find that they get relief from their pain but, after a couple of months this wears off. Others may experience complete relief. However there is a chance that the pain will not improve, not change or will get worse.

During the pain-free period you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike or swimming on your back will help to improve your muscle tone and strengthen your back. The best way is to increase your activity slowly.

Try not to overdo things on a good day as this may result in you experiencing more pain the following day.

How long will the pain relief last?

This varies between individuals. Some might notice immediate pain relief where in others it may take up to one to two weeks. However, pain relief may last from a few days to several months. Some patients do not get any pain relief from medial branch block.

Follow up appointment

A letter will be sent to your GP and you will be reviewed either by telephone or seen at the Pain Clinic in due course.

Points to remember

  • You will need to arrange for someone to take you home after this procedure.
  • Please bring your glasses if you need them for reading.
  • Always bring a list of all current medication.
  • Continue taking all your usual medication on treatment day.
  • If there is any possibility you may be pregnant please inform the doctor or nurse.

Additional information

If you experience unusual symptoms such as a marked increase in pain around an injection site, fever, severe headache, new symptoms of pins and needles, new muscle weakness in your arms and legs, or you are very concerned about how you feel after the procedure, please contact your doctor.

Should you require further advice about the issues contained in this leaflet, please do not hesitate to contact the Centre for Pain Medicine on telephone number (01482) 624093 or 624040.

Alternatively, you can contact The Pain Service at East Riding Community Hospital on telephone number (01482) 478868.

In the event of an emergency and outside normal working hours of the Pain Clinic (9.00am – 4.00pm), please contact your own GP.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

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We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.