Spinal Nerve Blocks
Nerve blocks can be performed for regional anesthesia, but also executed for pain management purposes. Common sites for nerve blocks are at the levels of the cervical and lumbar spine. These procedures can be performed in the thoracic spine, but these injections are less often performed, as nerve injury to the thoracic spine is less common. This may be attributed to the protected structure for the ribs at the level of the T-spine.
The injections are performed for both diagnostic and therapeutic treatments. A majority of the injections are performed outpatient—in the clinic or a same-day procedural facility. Some nerve blocks, such as epidurals, can be performed blind (without guided imaging) or under CT imaging, though most injections are performed under fluoroscopic guidance, utilizing x-rays. Injections should not be performed in those suffering an active infection. Precautions should be made—with consideration of possibly withholding injection—for those susceptible to infection. Patients should not be receiving an injection if they are receiving active anticoagulation or high dose blood thinning agents. There are specific American Society of Regional Anesthesia and Pain Medicine (ASRA) and American Society of Interventional Pain Physicians (ASIPP) guidelines to hold such medications prior to an intervention. Those with an allergy to contrast dye should not receive contrast confirmation during the injection, or the treating physician should withhold the injection altogether. Those pregnant should not receive an injection under x-ray exposure.