Less procedure times means better outcomes for patients. Most epidural injection procedures take 5-10 minutes and can be done in office or a hospital outpatient setting.
During an facet block, local anesthetic is applied to numb the skin and IV sedation is administered. This makes the procedure easier and helps make the patient more comfortable.
Under x-ray guidance, needles are placed just outside the facet joint, where the facet nerve sits. Once the needles are in place, correct position is confirmed by injecting a small amount of radiographic contrast at each site. Then the medication is administered.
The medication injected consists of a combination of local anesthetic (usually lidocaine or marcaine) and a steroid. The local anesthetic causes anesthesia, making the nerves ‘numb’. This helps interrupt the pain cycle and generally decreases pain. Although the local anesthetic wears off after a few hours, the effects may last due to ‘resetting’ of the pain nerves. The steroid usually will not take effect for days.
Patients often notice a gradual improvement in their pain over several days. The effects typically last weeks to months. It is important to note how much of your pain is gone on the day of the procedure. Make a note such as “pain is 70% percent gone” so that your doctor can assess your response.
If this block provides significant pain relief, then longer lasting radiofrequency ablation (RFA) of the nerve can be done.
The Dr. Webb Difference
Facet arthritis seems to be an extremely underdiagnosed cause of pain, particularly in the lower back. Many of our patients have seen multiple doctors and this is one of the most common procedures that we can do to significantly improve pain.
Many pain management doctors with inject into the joint itself because it is easier to access. However, if the procedure works and we want to do something more permanent (ie, RFA), then we have to place the needle at the location of the medial branch nerve--outside of the joint.
Therefore, in general, we almost always perform a medial branch block, rather than inject in the joint. The reason is that if you have success with blocking the nerve, this suggests greater success for the RFA.
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