CERVICAL MEDIAL BRANCH BLOCKS

A cervical medial branch block is a procedure performed to investigate the source of neck pain which has its origin in a cervical facet joint. This procedure is necessary because unfortunately there are no physical signs, nor x-ray features which are diagnostic of pain originating in facet joints. The only way therefore to determine if the pain is coming from a facet joint is to put a local anaesthetic onto the nerve that supplies the joint to decide whether the pain is relieved. The procedure therefore is a test and is not a treatment. If the pain does have its origin in the joint, then the patients pain will be relieved for a varying time depending on which local anaesthetic is used.

Before the Procedure

If you are pregnant or think you are pregnant, please tell the doctor as it is potentially hazardous to have x-rays during pregnancy.
You must have enough pain on the day of the procedure to determine whether or not the pain is relieved by the block. You may need to withhold your pain medications. If you do not have sufficient pain, then it is better to cancel the procedure by ringing Dr McLaughlin at Muscmed Ph 337 4839
Please arrange for a friend or relative to drive you home after the procedure, as you may be a little unsteady.

The Procedure

During the procedure you will lie on an x-ray table on your side with the painful side facing upward. An x-ray machine will be moved into position above your neck to obtain a good picture of your cervical spine. Your skin will be then cleaned with Iodine, a drape then placed over your face, but you will be awake and able to listen and speak during the procedure.

If you want the procedure to stop at any time, you can request this.

Once the x-ray machine is positioned, a needle will be inserted into the neck, which is felt often as a stinging sensation and then a discomfort as the needle goes through the muscles, down to the bone. When the needle is in the correct position, a small amount of local anaesthetic (0.3ml) is injected. The procedure is repeated again to anaesthetise the two nerves that are supplied by the joint.

The procedure takes about 30 minutes.

Following the Procedure

It is important that the pain levels are documented before the procedure and shortly after the procedure and at time intervals over the next 6 hours. This is critical in determining whether the local anaesthetic block was successful in alleviating your pain.

You will be asked to remain at the x-ray facility for up to an hour after the procedure and following this you will be asked to keep very good records of the times at which your pain returns – we may make telephone contact with you on the day of the injection and the following day to get an accurate record of the effects of the local anaesthetic.

The procedure if positive will be repeated again, as this improves the accuracy of results and the outcome of the next procedure which inactivates the nerve for some 10-18 months.

Remember it is important to tell us whether the pain has been relieved or not. If it has not been relieved, do not be afraid to say so. If only part of the pain is relieved, it is important for you to explain to me which part is relieved and which part is not.

Risks of the Procedure

Occasionally patients may feel faint during the procedure. If you feel this way, please tell the doctor so that the procedure can be interrupted or postponed.
If you have had allergic reactions to local anaesthetics, please let the doctor know before the procedure starts.
Following the injection some patients find that they have problems with their balance, but by looking straight ahead and focusing on the horizon, these effects are minimal.
It is not unusual for patients to have discomfort about the injection site, which is usually short-lived.
Infection into the skin is possible, although rare.
Infrequently if a patient has had total relief of their pain, when the pain returns it may be worse than the pain was prior to the injection. This severe pain however will settle quite quickly.

Treatment

If the cervical facet joint is determined to be the source of pain, then a procedure called a radio-frequency neurotomy is available.

Questions

If you have any questions about the procedure, please contact Dr Mark McLaughlin or Margaret who does the bookings on 03 337 4839.