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MEDIAL BRANCH BLOCKS

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WHAT IS A MEDIAL BRANCH BLOCK?
Primarily a diagnostic test to establish a potential pain generator from the facet joint of the cervical (neck), thoracic (mid-back) or lumbar (lower back) spine.  Research has shown, if 2 diagnostic medial branch blocks result in 80% or more pain relief during the 1st hour post procedure, the radiofrequency ablation (burning) of these nerves is about 90% successful at reducing pain for up to 18 months.

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WHAT ARE THE RISK OF A MEDIAL BRANCH BLOCK?
A medial branch block when performed under x-ray guidance is very safe.  However, when the skin is poke with a needle, there are risks.  These risks are as follows:

  • infection of the skin, muscle, bone or nerve (less then 1% risk)

  • bleeding, bruising and/or hematoma (blood collection) in the skin or muscle

  • increased pain post procedure (temporary)

  • Mid-Back procedures - very rare risk of puncturing the lung (pneumothorax)

  • allergic reaction to the skin cleaning solution, contrast dye, anesthetic

  • vasovagal reaction - sensation of faint (nausea, sweaty) - very temporary with no long term concerns.

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HOW DO I PREPARE FOR MY PROCEDURE?
We recommend holding your analgesic medication (Tylenol, Anti-inflammatory, opioid) the morning/day of the procedure.  Ideally, we need you pain to be 5/10 or higher to determine degree pain relief from the block.  After the pain returns, please resume your analgesics as directed.  Please don't stop any of your other medications.

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Please arrive 15 minutes before your appointment to allow enough time to check in with reception.

  • Bring photo identification and your provincial health card.

  • Wear comfortable clothes.

  • Please do not bring children who require supervision.

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WHAT HAPPENS DURING MY PROCEDURE?
Our staff will review the consent form with you.  The interventionalist (Physiatrist) doing the procedure will then meet you prior to the procedure to ensure that it is medically safe to do the procedure.

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Our x-ray technician will take you to the procedure room and comfortably set you up on the procedure table for the procedure.  The technician will then maneuver the x-ray machine (Fluoroscopy machine) over you to line up for the procedure.

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The interventionalist (Physiatrist) will then clean the area and take x-rays to establish the target site.  A needle is inserted into the skin and directed to the nerve locations under xray guidance.  A small amount of contrast is injected at the site to ensure no vessels will take away the anesthetic (freezing).  Then the anesthetic is injected at the location.  Depending on the number of joints being blocked will reflect the number of injections. A single facet joint requires 2 injections (2 needle pokes).

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After completion of the procedure, you will be escorted by to your seat in the main room.  A staff member will review you and give you instructions on how to complete the pain diary over the next 8 hours.  

 

IMPORTANT - the expected pain relief is only for 1 - 2 hours.  This is a test procedure to see where the pain is coming from.

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POST-PROCEDURE INSTRUCTIONS
First 24 hours:  Keep the treatment area clean and we recommend not soaking in water (bath, swimming or hot tub) for 24 hours.  You can shower at any time.

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Watch for infection: If you develop worsening pain, skin redness at the site of injection, or a temperature greater than 38.5°C, please proceed to an urgent care or emergency centre.

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Complete the pain diary and return it to Dr. Irvine by email (info@drjamieirvine.com) or through your clinic portal.

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You can resume taking your usual pain medications when the pain becomes unbearable following the procedure.

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If you have pain or other symptoms beyond 48 hours after your injection, please call our office at 587-400-3464 or email Dr. Irvine at info@drjamieirvine.com during business hours.

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