Selective Nerve Root Block

What is the epidural space and why is a selective nerve root block helpful?

The membrane that covers the nerve roots is called the dura membrane. The space surrounding the dura is the epidural space. Nerves travel through the epidural space before they form the nerves that travel down your arms, along your ribs and into your legs. The nerves leave the spine from small bony openings called foramen. Inflammation of these nerve roots may cause pain in your arms, chest or legs.

These nerve roots may become inflamed, for example, due to irritation from a damaged disc or contact with the bony structures of your spine. A selective nerve root block places anti-inflammatory medicine over the nerve root and into the epidural space to decrease inflammation of the nerve roots, therefore reducing your pain. The epidural injection may assist the injury to heal by reducing inflammation. It may provide permanent relief or provide a period of pain relief for several months while the injury/cause of your pain is healing.

What will happen to me during the procedure?

An IV will be started so that relaxation medication can be given. You will be placed on the X-ray table and positioned in such a way that your doctor can best visualize the bony openings in your spine where the nerve roots exit the spine using x-ray guidance. The skin will be scrubbed using two types of sterile scrub (soap). Next, the physician will numb a small area of skin with numbing medicine. This medicine stings for several seconds.

After the numbing medicine has been given time to be effective your doctor will direct a very small needle using x-ray guidance above the nerve root as it leaves the foramen. A small amount of contrast (dye) is then injected to insure proper spread of the medicine both around the nerve and into the epidural space. This may increase your usual pain for about 30 seconds. Then, a small mixture of numbing medicine (anesthetic) and anti-inflammatory (cortisone/steroid) will be injected.

What will happen after the procedure?

You will go back to the recovery area where you will be monitored for 30-60 minutes. You will then record the relief you experience during the next week on a post injection evaluation sheet (diary). This will be given to you when you are discharged home. You will also be given a follow up appointment. You will not be able to drive the day of the procedure. Your arm, chest wall or leg may feel weak or numb for a few hours.

General Pre/Post Instructions

If you are going to have anesthesia you need to be fasting for eight (8) hours prior to the injection. If you have having local anesthesia you should eat a light, but not a full meal within a few hours before your procedure. If you are an insulin dependent diabetic, do not change your normal eating pattern prior to the procedure. Please take your routine medications (i.e. high blood pressure and diabetic mediations).

If you are prescribed an anti-inflammatory, you need to stop taking this medication 5 days prior to the date of the procedure.These medicines can be restarted after the procedure if they are needed. If you are on Coumadin or Heparin (blood thinners) or Glucophage (a diabetic medicine) you must notify this office so the timing of stopping these medications can be explained. You will be at the office at least two (2) hours for your procedure. You will need to bring a driver with you. You may return to your normal activities the day after the procedure, including returning to work.

If you are unable to keep this appointment, please give notice as soon as possible and at least 24 hours in advance. Thank you.