Peripheral Nerve Root Block

Diagnostic and Therapeutic Benefits for Neck and Back Pain

The purpose of a peripheral nerve root block is diagnostic to determine if a specific peripheral nerve root is the potential source of neck or low back pain.  Besides the diagnostic benefits, some patients experience pain and symptom relief.

The procedure involves injecting a local anesthetic and corticosteroid into the nerve root sheath, a protective membrane (pia mater) covering each nerve root.  A corticosteroid is a powerful, slow-releasing, and long-lasting anti-inflammatory medication effective in reducing inflammation.

About Peripheral Nerve Roots

The brain and the spinal cord make up the central nervous system (CNS).  The CNS extends to the peripheral nervous system (PNS).  The PNS is a system of nerves that branch beyond the brain, brain stem, and spinal cord.  The purpose of the peripheral nervous system is to carry information to and from the central nervous system.

Nerves
Brain/brain stem, spinal cord, nerves roots, peripheral nerves (i.e. arm)

Causes of Peripheral Pain and Other Symptoms

There are many types of peripheral nerve disorders.  Some of these disorders are caused by other diseases such as diabetes, a virus, or infection.  Complex regional pain syndrome (CRPS) is a rare but chronic problem that may affect the arms or legs.  Other disorders cause nerve compression such as a herniated disc or spinal stenosis.  Some patients are born (congenital) with peripheral nerve problems.

Symptoms of a peripheral pain disorder may include pain, numbness, muscle weakness, and sensations such as burning or tingling.  Often, symptoms gradually worsen.

Patient Procedure Preparation

In advance of your procedure appointment, our medical team provides you with instructions specific to you and medications you regularly take.

If you take blood thinning medication, such as Coumadin, Plavix, aspirin, etcetera, please notify our medical team.  Certain drugs must be stopped several days before your procedure.

To fully benefit from a peripheral nerve root block, you must currently be experiencing symptoms, such as pain. 

Possible Risks and Complications

A peripheral nerve root block, like other medical procedures, may present risks.  Complications include risk of infection, low blood pressure, headache, injury to nerve tissue, and allergic reaction to medication.

What to Expect: The Procedure and After

Upon arrival at the treatment facility, you are received by our nurses in the preoperative area.  To fully benefit, you remain awake throughout the procedure to report symptoms and converse with your doctor.  Depending on the facility where your procedure will be performed, Dr. Assil allows one family member to be present in the operating room.

In the operating room, you are comfortably positioned and a cushion is placed either under your chest or abdomen.  Positioning and cushion placement is dependent on whether you are undergoing a cervical (neck) or lumbar (low back) procedure.  Next, the skin area is cleaned with a sterile soap.  A local anesthetic is injected and given time to take effect.

Using fluoroscopic guidance (real time x-ray), the doctor proceeds with the procedure and places the needle tip at the target area.  The doctor confirms the needle tip is properly positioned visually and fluoroscopically.  He then injects a small amount of contrast (dye) to ensure correct spread.  Next, a low volume anesthetic / steroid solution is injected into the specific location.  Rarely is pain increased during the injection.  However, our medical team is dedicated to making you as comfortable as possible.  A small band-aid covers the injection site.

Depending on the number of spinal levels injected (usually 2); the procedure takes 15 to 20 minutes.  Afterward, in the recovery area, you are closely monitored and given a snack.

Before you are released home, our medical team provides you with written home care instructions.  In general, you can expect one of the following:

  1. No pain relief
  2. Pain is relieved for a few hours, or days, and returns
  3. Pain is relieved, returns for a short time period, and then improves again

Conclusion

A member of our medical team will telephone you 24 to 48 hours after your peripheral nerve root block to follow-up.  We recommend you keep a daily journal of your pain level and other symptoms following your procedure.  Please be specific and keep in mind where pain and symptoms are in relationship to the injection site.  The pain diary will help you provide your doctor with detailed information about your treatment progress when you come back for your follow-up office visit.