As with many spinal injections, medial branch nerve block procedures are best performed under fluoroscopy (live X-ray) for guidance in properly targeting the nerves, placing the needle, and avoiding injury.

See Facet Joint Injections and Medial Branch Blocks

On the day of the injection, patients are advised to avoid driving and doing any strenuous activities, and to get plenty of rest the night before.

Medial Branch Nerve Block Steps

The medial branch injection procedure includes the following steps:

  • Commonly, the procedure is performed without any sedation, however, an IV line can be started if relaxation medicine is needed
  • The patient lies face down on an procedure table, and the skin over the area to be tested is well cleansed
  • The physician treats a small area of skin with a numbing medicine (anesthetic), which may sting for a few seconds
  • The physician uses X-ray guidance (fluoroscopy) to direct a very small needle over the medial branch nerves
  • A small amount of contrast dye is then injected to confirm that the medicine covers the medial branch nerve
  • Following this confirmation, a small amount of numbing medicine (anesthetic) will then be slowly injected onto each targeted nerve.

The injection itself only takes a few minutes, but the entire procedure usually takes between fifteen and thirty minutes.

After the Injection

After the procedure, the patient typically remains resting in the recovery area for 20 to 30 minutes. The physician will then ask the patient to perform some movements or activities that would usually provoke the pain. This assessment is done in order to determine if the medial branch nerve block has reduced the patient's pain.

Dr. Ray Baker is an anesthesiologist specializing in interventional pain medicine and non-surgical spine care. He has more than 25 years of clinical experience serving on staff in hospitals and medical centers in Washington state.

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