Medial Branch Nerve Blocks

Procedure Description:

A medial branch nerve block (MBNB) is a targeted injection of a small dose of local anesthetic to selectively numb spinal joints (facet joints) for diagnostic value. Pain arising from arthritic facet joints are transmitted through the MBNs. Numbing these nerves and seeing if the pain decreases can help determine if the pain is coming from the joints that were numbed. It is important to understand that the numbing effect is very temporary, typically lasting only 8-10 hours at the most. This is a commonly performed procedure with a low risk of side effects.

What it treats:

Neck pain, upper back pain, lower back pain arising from painful injured or arthritic spinal joints.  This usually presents as pain and stiffness closer to the spine, aggravated with movement, spinal extension, and worse in the mornings and at the end of the day.

How it is performed:

A MBNB is performed using a special X-Ray machine called a fluoroscope. This allows the provider to target the injection quickly and effectively. The procedure typically takes less than 5 minutes. The provider numbs the area before the injection to minimize discomfort.

Pre-procedure instructions:

Wear loose clothing without metal buttons or zippers to the procedure. Typically the procedure is performed without IV sedation, however, if sedation is utilized, make sure to not eat or drink for 12 hours prior to the procedure. Also, no driving is advised for 12 hours after the procedure, so a driver home is required. If IV sedation is administered, the driver must be a friend or family member. If no IV sedation, then can be a ride service such as Uber. Typically medications that prevent clotting (blood thinners) do not need to be held for a MBNB.

What to expect after the procedure:

Since this is a diagnostic procedure, it is important to monitor and track your pain level very closely for the first 12 hours immediately following the procedure. By the next day, the medicine is no longer active, it is the same day of the procedure that is important. Make sure to write down the pain levels on the provided pain diary. If you experience a new soreness from the procedure, try to separate this in your mind from your usual pain. You are measuring your usual pain. If your pain is only present with certain activities or movements, you should perform these within moderation to test to see if there is any change in pain level. If substantial, temporary pain relief is noted with the first injection, a repeat, confirmatory injection will be recommended before moving on to the treatment that can provide longer lasting pain relief (RFA).