Selective Nerve Root Block

What is Selective Nerve Root Block

Selective nerve root block is a procedure to inject a numbing medicine (anesthetic) into an area of the spine where a nerve leaves the spinal cord (nerve root). In most cases, a strong anti-inflammatory medicine (steroid) is also injected.

This procedure is often done to help diagnose the source of pain in the back, leg, neck, or arm. The injection may temporarily reduce or eliminate pain in the part of the body that is supplied by the nerve.

A nerve root block can be done in the upper (cervical), middle (thoracic), or lower (lumbar) spine, or at the base of the spine (sacrum).

During the procedure, a long needle (spinal needle) will be inserted between the spinal bones (vertebrae) to inject medicine into the nerve root.

Tell a health care provider about:

  • Any allergies you have.
  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
  • Any problems you or family members have had with anesthetic medicines.
  • Any blood disorders you have.
  • Any surgeries you have.
  • Any medical conditions you have.
  • Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

  • Infection.
  • Bleeding.
  • Allergic reactions to medicines or dyes.
  • Damage to nerves or blood vessels.
  • Leaking of spinal fluid, causing a severe headache (spinal headache).
  • A temporary increase in pain right after the procedure.
  • Muscle weakness or a loss of movement or feeling (paralysis).
  • Temporary nausea, diarrhea, or facial warmth and redness (flushing), if a steroid is injected.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

  • Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.

General instructions

  • Ask your health care provider about:
    • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
    • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
    • Taking over-the-counter medicines, vitamins, herbs, and supplements.
  • Plan to have someone take you home from the hospital or clinic.

What happens during the procedure?

  • To lower your risk of infection:
    • Your health care team will wash or sanitize their hands.
    • Your skin will be washed with a germ-killing solution.
  • Medicine will be injected to numb the skin over the area where the spinal injection will be given (local anesthetic).
  • You may be given a medicine to help you relax (sedative).
  • A spinal needle will be inserted through an opening (foramen) in the vertebrae to reach the nerve root (transforaminal injection).
  • X-ray dye (contrast dye) will be injected into the nerve root area.
  • X-rays (fluoroscopy) will be done to make sure the spinal needle is in the correct position. Contrast dye helps to make your body structures show up clearly in the X-ray images.
  • Anesthetic will be injected into the nerve root. Steroid medicine may also be injected.
  • You may be asked if you feel pain relief.
  • The spinal needle will be removed.
  • A bandage (dressing) will be placed over the injection (puncture) site.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

  • The injection may temporarily reduce or eliminate pain in the part of the body that is supplied by the nerve. Your health care provider may ask questions about your pain.
  • Your blood pressure, heart rate, breathing rate, blood oxygen level, strength, and coordination will be monitored for about 30 minutes.
  • Do not drive for 24 hours if you were given a sedative.

Summary

  • Selective nerve root block is a procedure to inject a numbing medicine (anesthetic) into an area of the spine where a nerve leaves the spinal cord (nerve root).
  • This procedure may help diagnose the source of pain in the back, leg, neck, or arm.
  • Before the procedure, follow instructions from your health care provider about eating and drinking restrictions.

Selective Nerve Root Block, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to feel some discomfort at the injection (puncture) site.

The injection may temporarily reduce or eliminate pain in the part of the body that is supplied by the nerve.

Follow these instructions at home:

Activity

  • Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during the procedure.
  • Do not lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your health care provider says that it is safe.
  • Return to your normal activities as directed. Ask your health care provider what activities are safe for you.

Puncture site care

  • Remove your bandage (dressing) 24 hours after your procedure, or as told by your health care provider.
  • Check your puncture site every day for signs of infection. Check for:
    • Redness, swelling, or pain.
    • Warmth.
    • Fluid or blood.
    • Pus or a bad smell.

General instructions

  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not take showers or baths, swim, or use a hot tub until your health care provider approves. In most cases, you may shower and bathe starting 24 hours after your procedure.
  • If directed, put ice on the puncture area to relieve discomfort.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

  • You have redness, swelling, or pain around your puncture site.
  • You have fluid or blood coming from your puncture site.
  • You have pus or a bad smell coming from your puncture site.
  • Your puncture site feels warm to the touch.
  • You have a fever.

Get help right away if:

  • You have:
    • Shortness of breath.
    • A severe headache.
    • Pain that gets worse.
  • You develop weakness or loss of feeling (numbness).
  • You develop muscle weakness or paralysis.

Summary

  • Do not drive for 24 hours if you were given a sedative.
  • Check your puncture site every day for signs of infection.
  • Return to your normal activities as directed. Ask your health care provider what activities are safe for you.
  • Take over-the-counter and prescription medicines only as told by your health care provider.

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