Nerve Blocks and Radiofrequency Ablation

Nerve Blocks and Radiofrequency Ablation

A nerve block is a procedure in which an injection of an anesthetic is delivered to a specific nerve to relieve pain. Your doctor may also use nerve blocks as a diagnostic tool to determine the source of your pain. Radiofrequency ablation of a nerve is sometimes used to provide longer lasting pain relief after a diagnostic nerve block.

  • Procedure in which an injection of an anesthetic is delivered to a specific nerve to relieve pain.
  • Your doctor may also use nerve blocks as a diagnostic tool to determine the source of your pain.

Services Offered:

    • Medial Branch Nerve Block
    • Genicular (Knee) Nerve Block
    • Intercostal Nerve Block
    • Peripheral Nerve Block

1 - Medial Branch Blocks and Radiofrequency Ablation

1. What are facet joints?

Facet joints are located in the posterior aspect of the spinal column. These joints help with mobility and movement of the spine. Sometimes, these joints can become inflamed or develop arthritis, leading to pain.

2. What are medial branch nerves?

Medial branch nerves carry pain information from the facet joint and the surrounding muscles to the spinal cord.

What injections can be performed for pain that is coming from facet joints?

Injections into the facet joints with local anesthetic (“numbing” medication) and steroid (anti-inflammatory) can reduce inflammation in the joints. More commonly, medial branch nerve blocks and radiofrequency ablation can be performed.

3. Facet joint injections

You will be positioned on your abdomen. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection.

Local anesthetic (“numbing” medication) will be injected into the skin. Contrast dye will be used to confirm that the needle tip is in the facet joint. Then, local anesthetic and steroid will be injected.

4. The Procedure

Medial branch nerve block (diagnostic or “test” procedure) and radiofrequency ablation (“burning” procedure)

You will be positioned on your abdomen. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your spine to determine the correct placement of the needle for the injection. Local anesthetic (“numbing” medication) will be injected into the skin.

For a diagnostic nerve block, local anesthetic will also be placed near the medial branch nerve.

For a radiofrequency ablation (“burning” of the nerve to disrupt the pain signaling), the needle tip placement will be confirmed with testing, which typically feels like “tapping” or vibration. Then, local anesthetic will be injected to numb the area before performing radiofrequency ablation at each site.

5. Before the procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

– Shoulder Joint Injection
– Hip Joint Injection
– Knee Joint Injection

6. After the procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

If this was a diagnostic nerve block, the local anesthetic will wear off in several hours. Your pain will return – however, what is important is whether your pain, function, and/or movement improved while the local anesthetic was present. If you received greater than 50% pain relief and/or improved function during the brief time after the injection, then you will be offered a radiofrequency ablation.

The average pain relief after radiofrequency ablation is 6-18 (until the nerves regrow). If this procedure provides at least 6 months of pain relief, it can be repeated, if needed.

2 - Genicular Nerve Block and Radiofrequency Ablation

1. What are genicular nerves?

The genicular nerves carry pain signals and sensation from the knee, to other nerves that send signals to the spinal cord.

Genicular nerve blocks and radiofrequency ablation can be performed to help reduce knee pain.

2. The Procedure

Genicular nerve block (diagnostic or “test” procedure) and radiofrequency ablation (“burning” procedure)

You will be positioned on your back or sitting. Your heart rate, blood pressure, and oxygen level will be monitored during the procedure. The injection site will be washed with a sterile cleaning solution. X-ray images will be taken of your knee to determine the correct placement of the needle for the injection. Local anesthetic (“numbing” medication) will be injected into the skin.

For a diagnostic nerve block, local anesthetic will also be placed near the genicular nerves (3 locations – 2 above the knee and 1 below the knee).

For a radiofrequency ablation (“burning” of the nerve to disrupt the pain signaling), the needle tip placement will be confirmed

with X-ray imaging. Then, local anesthetic will be injected to numb the area before performing radiofrequency ablation at each site.

3. Before the procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

 

4. After the procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

3 - Other Peripheral Nerve Blocks

1. What are peripheral nerves?

Peripheral nerves are located outside the brain and spinal cord and carry information (including pain signals) to the brain.

The goal of a nerve block is to “numb” the nerves that carry the pain message, hopefully breaking the cycle of pain signaling. Steroids are sometimes added to increase the duration of the nerve block and decrease inflammation.

2. The Procedure

You will be positioned either in the bed or on a chair. Your heart rate, blood pressure, and oxygen level may be monitored during the procedure. An IV may also be placed. The injection site will be washed with a sterile cleaning solution. Depending on the nerve location, the site may be identified by feel, or palpation (such as occipital nerve blocks). X-ray or ultrasound may be used to identify the nerve as well (such as intercostal, ilioinguinal, femoral, or saphenous nerve blocks).

Local anesthetic (“numbing” medication) will be injected into the skin. Then, a needle will be placed near the target nerve. Local anesthetic will be injected at that site; sometimes, other medications, such as steroids, will be injected as well.

3. Before the Procedure

It is important that you follow all pre-procedure instructions given to you at your clinic visit; if not, your procedure may be canceled.

After the Procedure

You will remain in the recovery room for observation; we will monitor your vital signs during this time. The staff will give you discharge instructions.

Hess Orthopaedic Specialties

What is it?

  • Pain management is individualized treatment of chronic pain for each patient which is offered through a variety of different services.

How can you determine if the pain is temporary or chronic?

  • Temporary pain can result from injuries or other trauma and may last up up to a few weeks or a few months depending on the injury. The pain will typically go away after the injury is healed.
  • Chronic pain can result from injuries or other trauma and will last more than 3 months. The pain is still present even after the injury is healed. Others can experience chronic pain even with no signs of injury or trauma.

How can a pain medicine specialist help you?

Doctors who specialize in pain management:

  • Cubital Tunnel Syndrome is caused when your ulnar nerve, commonly known as the “funny bone”, experiences pressure or compression.

Symptoms

  • Will ask you about the pain you are experiencing
    • Where does it hurt?
    • How long has it been hurting?
    • What makes it feel better or worse?
  • Will review test and records, such as x-rays or other images, to determine what may be the best form of treatment
    will have you fill out a questionnaire, this individualizes the experience you are having and provides specific information about your pain