https://www.medilaw.tv - This movie illustrates the technique for performing a cervical selective spinal nerve block. This movie shows patient positioning, skin preparation, local anesthetic injection, needle introduction into the intervertebral foramen, contrast injection to check the needle tip position, steroid / anesthetic injection, and finally wound dressing.
Spinal nerves relay sensation messages from the body to the spinal cord and brain, and relay instructions from the brain to the body. Pain to and from a particular region in the body is transmitted via known spinal nerves. In addition, direct irritation of a spinal nerve can cause pain messages to be transmitted to the brain from that spinal nerve. The brain interprets these messages as originating in the region of the body that usually sends messages to the brain via that spinal nerve. This is called radicular pain, and is often caused by spinal nerve irritation by a herniated disc, bone spur or hyper-extension injury.
A selective spinal nerve block, or selective nerve root block, is used to inject medication around a particular spinal nerve. The medication usually includes local anesthetic, and may include slow-release steroid. The amount of immediate pain relief from the local anesthetic indicates the degree to which the nerve is transmitting or causing your pain. This information will assist with the selection of further treatment options. The steroid acts as an anti-inflammatory to decrease irritation of the nerve. This can provide ongoing pain relief so that a rehabilitation program can be commenced.
Indications for selective spinal nerve blocks are
-- pain in a region of the body supplied by a particular nerve root
-- recent physical examination and radiological imaging that don't assist diagnosis
-- post-operative clients with unexplainable recurrent pain
-- clients requiring temporary pain relief from a known cause of regional pain.
The non-surgical alternatives to selective spinal nerve blocks may be
-- activity modification
-- weight loss
-- aerobic exercise, such as walking, cycling, and swimming
-- strength and flexibility exercises
-- physical therapy
-- heat and cold pads
-- pain-relieving medications such as acetaminophen or paracetamol, non-steroidal anti-inflammatory drugs, glucosamine, chondroitin
-- The surgical alternatives to selective spinal nerve blocks may be
-- steroid and local anesthetic injections
-- surgical decompression and possibly fusion.
It is your right to delay or refuse the recommended treatment for your condition. However, this delay or refusal may lead to the worsening of your symptoms, such as increased arm pain, pins and needles, weakness or numbness. You should ask your doctor what might happen should you choose not to undertake the recommended treatment.
Before the selective spinal nerve block
- cease blood thinners as instructed ie coumadin/warfarin, plavix, heparin, aspirin
- let your doctor know all the medications you are taking including herbal medications that can increase bleeding risk ie vitamin E, glucosamine, chamomile, danshen, garlic, gingko, devil's claw, ginseng, fish oil, willow bark, feverfew, and goji berries
- you should take your routine medications, but stop any pain relievers or anti-inflammatory medication for the day. You need to have some pain, so you can assess whether the injection gives you any pain relief.
- you will be admitted into the hospital on the day of the procedure
- bring your radiological images and reports ie X-rays, CTs, MRIs, etc
- don't eat or drink for the few hours before the procedure.
- wear loose-fitting clothes that are easy to take off and put on. Do not wear any jewelry.
- before the procedure, the skin on your neck will be cleaned and you will be given a general health check. The skin on your neck may be shaved.
- an intra-venous line may be placed into a vein in your arm to administer fluid and medications
- let your doctor know if you develop a fever, cold or flu ...