FAQs on Medial Branch Nerve Block

 

A medial branch block is a type of office injection that uses a strong anesthetic delivered to the medial branch nerves that supply the posterior facet joints along the spine. This block is used to provide long-term pain relief.

What are the facet joints?

Also called the zygapophysial joints, the facet joints are part of the bony spinal framework. These tiny projections are on either side of a vertebra, where the bone meets with the bone above or below it. The facet joints can become inflamed from arthritis and spine problems.

What symptoms are associated with facet joint syndrome?

The medial branch nerves often are irritated with facet joint syndrome. Symptoms include:

  • Neck pain radiating down one shoulder and/or arm
  • Lower back pain radiating down one buttock and/or leg
  • Burning or aching pain
  • Worsening pain with rotating the shoulder, moving the head from side-to-side, or bending at the waist from side-to-side

How many joints/nerves are injected at one procedure setting?

The doctor may inject several medial branch nerves during once scheduled procedure. This involves inserting small needles into the joint region and injecting an anesthetic or neurolytic agent.

How long does a medial branch block take?

The actual injection takes only a few minutes. However, you should allow 90-120 minutes for the appointment, which includes sign-in, signing forms, starting and IV, cleaning your back, and recovery room with the nurse afterwards.

What medications are used during the medial branch block?

Solutions used during the block include:

  • An antiseptic, such as Betadine
  • An anesthetic, such as bupivacaine or lidocaine
  • A sedative, such as Valium or Versed
  • A neurolytic agent, such as phenol or alcohol

Does the medial branch block hurt?

The procedure first involves numbing the back with a local anesthetic through a tiny needle. This may feel like a slight pinch followed by mild burning. During the nerve injection, you may feel some pressure at the injection site. After the procedure, expect to feel some soreness at the injection sites. Because IV sedation is used, you will have little or no memory of the procedure.

How is the medial branch block done?

You will first be positioned on your stomach. The nurse places an IV catheter in your arm and attaches monitoring devices to your finger and arm. After your back is cleaned with an antiseptic, the doctor numbs the deeper tissues with an anesthetic. After the medication is instilled, the needle is removed. A small bandage is placed over injection sites.

What happens after the procedure?

Because a sedative is used, you cannot drive yourself home. Arrange to have someone take you home. We recommend resting for 1-2 days, and gradually return to usual duties and activities. The back region will be slightly tender, but use an ice pack for pain relief.

How many medial branch block procedures will I need?

Sometimes, several facet joints are injected at one session. Multiple levels are blocked simultaneously, but the doctor may schedule you in for radiofrequency lesioning if the medial branch nerve block is effective. Most patients have pain relief immediate and then pain gradually resolves over the next few weeks.

Do medial branch blocks work?

In a two-year study, researchers evaluated lumbar medial branch block efficacy. They found that these blocks had a 93% success rate after one year, and a 90% success rate after two years.

Resources

Boswell MV, Colson JD, Sehgal N, et al. A systematic review of therapeutic facet joint interventions in chronic spinal pain. Pain Physician. 2007;10(1):229-253.

Cohen S, Strassels S, Kurihara C, et al. Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes. Anesthesiology. 2010;112:144-152.