Nerve Root Block Procedure

Your Consultant has requested for you to have a Nerve Root block.  This is carried out in the X-Ray Department by a Consultant Radiologist, Radiology Fellow or Registrar.

 

What is a Nerve Root Block?

A Nerve Root Block is a procedure performed to help reduce pain and also for your referring Consultant to pinpoint the exact area causing your pain. Two types of drug can be injected, Local anaesthetic and also a steroid.  Local anaesthetic will give you pain relief for only a number of hours, but the steroid can potentially give longer lasting pain relief.  There is no steroid licensed for this use, but it is considered to be safe practice in the UK and also throughout the world.

 

Preparation Required Prior To Your Nerve Root Block

Please arrive at the X-Ray Reception at your appointment time. On arrival you will be given a thorough explanation of the procedure by the Radiologist performing or assisting the procedure. If you have any questions or are unsure of anything please ask.  The Radiologist will ask you to give written consent prior to the procedure.

Following consent, you will be shown to a cubicle and asked to change into a gown.

 

The Procedure In The X-Ray Department

The procedure is performed under X-ray (fluoroscopy) or Computed Tomography (CT) guidance.  You will be asked to lie face down on the X-ray or CT table and you will be made as comfortable as possible.

It is very important that you keep still once the procedure starts.  Please try to relax and avoid moving any part of the body including the head.  Several X-Ray views or CT scans may be required to position the needle throughout the procedure.

Your skin will be cleaned with antiseptic solution and a sterile drape will be placed over the area.  Some local anaesthetic will be injected to numb the skin.  A longer needle is then inserted and advanced towards the nerve under X-ray or CT guidance.  A small amount of X-ray dye is injected to confirm the needle position.

Once the position of the needle is confirmed, the drugs are injected. When the drugs are injected you might experience pain as the nerve may get irritated.

The needle is then withdrawn and a small dressing is applied to the area.  You will then be helped off the table.  Sometimes your limbs may feel weak due to the effects of the Nerve Root Block. The may last for several hours therefore it is important that you report to us any unusual sensation. 

 

We ask that someone accompanies and drives you home.

You will be in the department for approximately one hour. 

Following the procedure you will be asked to stay in the X-ray Department Reception for approximately 15 to 20 minutes to ensure that you feel well before you leave. 

The Consultant Radiologist may come and speak to you before you leave.

 

Are there any side effects?

Serious side effects are rare; however you need to be aware that the following can occur:

• Bleeding: this could cause bruising, increased pain, or in exceptional cases nerve compression.

• Infection: during any procedure where a needle passes through the skin it is possible that bacteria may enter at the same time. One way to reduce the risk is to only do the procedure if you are free of any infection anywhere in your body.

• Nerve or Spinal cord damage: (Very rare) this could be temporary or permanent, could cause more severe pain than you are experiencing now, paralysis, paraplegia/tetraplegia (loss of bodily function below the level of injection). This life changing and very serious complication has happened in other centres.

• Stroke: (very rare) after a cervical (neck) nerve root block

• Pain: at the injection site. This is temporary and will resolve quickly. You may also notice a temporary flare up of your pain for 2 to 3 days after the procedure.  The procedure may also not reduce your pain.

• Injections in the upper back/ back of chest (thoracic area only) can very rarely cause Injury or collapse of the lung (pneumothorax). You should seek urgent medical attention if you get chest pain or breathlessness

• Allergic reaction to the drugs or x-ray dye used: this can vary from slight to life threatening, though this is very rare.

• Very occasionally people may feel faint due to temporary fall in blood pressure

• Headache: Very rarely the needle may be inserted too far into where the cerebrospinal fluid (CSF)   runs in the spine. This may cause leak of the fluid and may lead to severe headache which may require treatment.  If a headache does develop following your injection, take some Paracetamol, drink plenty of water and lie flat. If the headache worsens or continues for more than twenty-four hours then please seek medical attention.

• Side effects associated with steroid medication: these may include fluid retention, flushing of the face, headache, impaired sleep, mood changes and weight gain. It can also disrupt ladies’ periods for up to 2 cycles.

• The procedure may be abandoned: it may not be possible to safely position the needle in the correct place.

Please contact the X-Ray Department prior to the procedure if:

• there is any chance you could be pregnant due to the use of X-rays during this procedure.

• you are on blood-thinning medication such as Warfarin (Coumadin), Clopidogrel (Plavix), Ticlopidine (Ticlid), Apixaban (Eliquis), Dabigatran (Pradaxa) and Rivaroxaban (Xarelyo). These will need to be stopped safely for a period of time before the procedure.

• if you have an infection in your body, including a chest infection, or on the skin of your back or if you have diarrhoea.

• if you have any drug allergies or any other allergies.

If you feel unwell when you return home, please contact your GP or call NHS Direct