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Nerve root block in London

A nerve root block is a technique to produce loss of feeling, otherwise known as anaesthesia. It can be used to diagnose and, if necessary, treat the cause of your pain and avoid surgery.

ORTHOPAEDICS | NERVE ROOT BLOCKS

Introducing the service

A nerve root block is the most effective method of controlling or preventing pain providing rapid relief from discomfort. They may also provide longer-term relief since some injections minimise nerve irritation and allow them to recover. It can be used to determine the source of your pain, provide pain relief or treat conditions, such as facet joint arthritis. A nerve root block is also used during surgical procedures where total loss of feeling is required for your comfort. Our experts have extensive experience with the procedure and use the most up-to-date techniques to provide excellent treatment.

 

Non-surgical nerve blocks can be used to avoid surgery by injecting medication into a specific nerve or a group of nerves to reduce or stop pain. Surgical nerve blocks stop pain sensations by cutting or eliminating certain nerves and has the potential to be permanent. Surgical nerve blocks are usually reserved for uncommon cases of persistent pain that have failed to respond to previous treatments, such as chronic regional pain syndrome.

There are four categories of nerve blocks based on what they are used for:

Therapeutic nerve blocks are used to treat chronic pain. The injection contains local anaesthetic to relieve acute pain. Studies show these nerve blocks help improve the quality of life for people with chronic pain.

Diagnostic nerve blocks are used to determine the source of your pain. Your Consultant may be able to pinpoint the cause of your pain and how to manage it by observing how a nerve block affects it.

Prognostic nerve blocks are used to see if more permanent therapies (such as surgery) would be effective in reducing pain.

Pre-emptive nerve blocks are unique because they are utilised to prevent pain that commonly follows surgical procedures.

 

 

Who is the ideal candidate for a nerve root block?

Your Consultant may recommend a nerve block to diagnose or treat short-term, acute or chronic pain. Common uses for nerve blocks are:

  • Pain due to arthritis
  • Lower back pain or in rare cases sciatica
  • Headaches, including migraines and occipital neuralgia
  • Pain before, during, and after a surgery, such as a joint or knee replacement
  • Chronic regional pain syndrome
  • Neck pain caused by herniated disks
  • Raynaud’s syndrome
  • Excessive sweating

You must inform your Consultant if you are diabetic as it may not be safe to proceed with a nerve root block injection if your blood sugar levels are high. You must also inform your Consultant if you have chronic kidney disease as you may have an allergic reaction to the medications or dye used in the procedure.

You will be unable to have the procedure if you have an active infection, cold, flu, fever, very high blood pressure or are taking medication to thin the blood.

Getting to the root of the problem

A nerve root refers to the location where a nerve leaves the spinal cord through a gap between adjacent vertebrae.

A nerve root block refers to the injection of a combination of anaesthetic to numb pain and steroid an anti-inflammatory around a nerve root. A nerve root block takes about 20-30 minutes to perform and you will need to allow several hours for recovery time.

Nerve root pain is where a nerve root is compressed or irritated resulting in pain, pins-and-needles, tingling, numbness, and/or paralysis. Nerve root pain is caused by underlying conditions such as:

  • Arthritis
  • Inflammatory disease
  • Spinal injury or infection
  • Degenerative spinal conditions, such as spinal stenosis
  • Spondylosis
  • Bone spurs
  • Herniated discs
  • Abnormalities, such as tumours, cysts, hernias, and hematomas

What happens during a nerve root block procedure?

A nerve root block does not require any special preparation and is performed as a day case, so you will not normally have an overnight stay. You are free to eat and drink normally before the procedure. However, if you are diabetic you need to monitor your blood sugar levels and not take your anti-diabetic medication before having a nerve root block.

The procedure takes between 20 to 30 minutes and will be carried out with you lying on your front or side. Then the skin around the injection site is cleansed with an antiseptic. A local anaesthetic will be administered to numb the injection site and surrounding area. However, in some cases your surgeon may decide to inject a sedative to put you to sleep throughout the procedure.

Once the local anaesthetic or sedative has taken effect, your surgeon will inject a tiny amount of contrast dye and use an x-ray to locate the nerve root. Once the needle's precise location has been confirmed your surgeon will inject the nerve root block just outside the nerve root to ease pain and reduce inflammation. It normally takes 5 – 10 minutes to treat each affected nerve root.

After the treatment, you'll be taken to a recuperation area where you will be assessed. Your blood pressure and pulse will be checked by a nurse.

If you've been sedated, oxygen may be administered through a facemask to help you wake up.

If you had a nerve root block for diagnostic purposes, your Consultant will ask you if your pain has stopped or been significantly reduced.

You can normally go home within a couple of hours of having a nerve root block injection, longer if you have had multiple nerve root injections.

Recovery & rehabilitation after nerve root block treatment

Depending on the type of nerve root block used, you will experience numbness or weakness which may last anywhere from 12 to 36 hours.

You will most likely notice pain relief in the injected area after the procedure. This can last anywhere from one to two weeks, and in some cases, much longer.

However, it is usual for pain to reappear after the numbness has worn off, sometimes significantly greater than before. As steroid injections take time to work, this could take several days or even weeks.

After your treatment, you must not drive for the rest of the day so you need to arrange for someone to drive you home or accompany you in a taxi. If you’ve been sedated you must not drive for 48 hours after the procedure and have someone stay with you overnight. For the rest of the day, no heat should be applied to the injection site, you should not shower or have a bath or immerse the injection site in water. Within 24 hours following your nerve block, don't take any anti-inflammatory medications like ibuprofen or naproxen.

If you have diabetes your blood sugar may increase after this procedure. You should plan to monitor your blood sugar concentration carefully for the first few days after the injection and should know how to adjust your anti-diabetic medication.

You can resume your regular diet and medications after surgery, unless your Consultant advises otherwise and you can start work after 24 hours.

The majority of patients experience significant pain relief after a nerve root block injection and the effect may last years. If the initial injection is successful, your Consultant may advise you to repeat it, but not for at least six months.

If the symptoms do not improve after six weeks or if the alleviation is only temporary, in some cases your Consultant may recommend an operation to treat the affected nerve root.

Risks and possible complications of nerve root blocks

Nerve blocks are very safe, but they do come with some risks, just like any other medical operation. In general, nerve blocks have less adverse effects than most other pain drugs.

  • If you are diabetic you may have elevated blood sugar for a few days.
  • Bleeding, especially if you have been taking blood thinning medication.
  • Pain and/or bruising at the injection site.
  • Infection, but this is extremely rare. Skin conditions like psoriasis or eczema can increase the risk.
  • Allergy to medications or contrast dye.
  • Nerve damage. If the membrane around the nerve was damaged this can result in a small leakage of cerebrospinal fluid. This can cause headaches for a few days when standing or walking. Lying down until the leakage stops resolves this.

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