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Medial Branch Block

What is a Medial Branch Block?

A Medial Branch Block is a chemical sensory nerve block that temporarily blocks the pain caused by cervical, thoracic or lumbar facet joint problems. Medial branch nerves are the small nerve branch that control sensation to part of facet joint. The facet joint is where each bone of the spine (vertebrae) connects with the next. Medial branch blocks can be uses as a diagnostic test to determine if a patient will benefit from a minimally invasive procedure called a medial branch rhizotomy. A medial branch block is temporary and the medication is eventually absorbed into the body, so it is not unusual for your symptoms to come back again.

What happens during the procedure?

Prior to the injection, you will be asked to sign a consent form. A nurse will check your vital signs, and ask what medications you are currently taking and if you are allergic to any medications. Patients may choose to remain awake for the entire process. Some physicians may offer the choice of an oral medication to relieve anxiety, while others offer IV sedation. The doctor performing the injections will review your medical history and talk with you prior to the procedure.

Lying face down on the table, in the procedure room, the area of injection will be cleansed with an antiseptic solution and the skin will be numbed.

With the assistance of a C-arm fluoroscopic unit (x-ray) the physician directs a needle through the skin into the facet joint and the anesthetic and corticosteroid are delivered. These medications help to reduce inflammation and relieve pain.

After the injection, you will return to the recovery room for 30 minutes of observation. The nurse will re-check your vital signs at this time. You will be given an ice pack to use for the remainder of the day to help keep the medication in place for maximum benefit and to relieve any soreness. You may resume normal activity the next day.

A form to periodically notate your pain levels post-injection will be given to you prior to discharge. Please bring this form with you to your follow-up appointment.

How do I prepare for the injection:

  • Nothing to eat or drink 6 hours prior to injection.
  • Discontinue all medications after midnight before your injection. If you are on routine medications for heart, blood pressure or diabetes, you can take your medication as usual the morning of your injection with a sip of water.
  • Discontinue anti-inflammatory medication such as ibuprofen or naproxen three days prior to the injection.
  • Discontinue aspirin products seven days prior to your injection.
  • If on blood thinners such as Coumadin, Plavix or Pradaxa, contact the prescribing physician to stop the medication seven days prior to injection.

What do I need to do on the day of the injection?

  • You must have an adult driver with you
  • Make and bring a list of all medications, both prescribed and over-the-counter with you to the injection along with your photo identification and insurance card(s).
  • Plan to arrive one hour prior to your injection time to check-in and register at the facility.

Other than pain, associated symptoms may include weakness, numbness or tingling.

Fortunately, most forms of back pain get better on their own: approximately 50 percent of patients will experience back pain relief within two weeks and 90 percent within three months.

If the pain lasts for more than a few days, is getting worse, does not respond to back pain remedies such as a short period of rest, using ice or heat, lower back pain exercises and over-the-counter pain relievers, then it is usually advisable to see a back doctor.

Drug Information

Anti-inflammatory drugs that need to be stopped 3 days prior to your injection

  • Advil,Ibuprofen, Nuprin, Motrin
  • Naprosyn, Naprelan, Naproxyn, Alleve, anaprox
  • Lodine, Etodolac
  • Orudis, Oruvail, Ketoprofen
  • Ansaid
  • Cataflam, Voltaren, Diclofenac, Arthrotec
  • Feldene, Iroxicam
  • Tolectin, Tomletin
  • Nalfon, Fenoprofen
  • Meclomen, Meclofenamate
  • Daypro, Oxaprozin
  • Clinoril, Sulindac
  • Indocin, Indomethacin
  • Relafen (Nabumetone)
  • Dolobid, Difunisal
  • Ponstel, Mefenamic Acid
  • Toradol, Ketoralac
  • Mobic

Aspirin products to stop taking 7 days prior to your injection:

  • Apsirin, Bufferin, Excedrin, Disalcid, Salsalate, Alka Seltzer Plus, Trisilate
  • Anything that has “salicylic” or “salicylate” on the label

It is alright to continue taking:

  • Celebrex

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