Common Procedures

Benefits of Intervention

  • Evidence Based Treatment
  • Minimally Invasive (only needle prick required)
  • Almost painless
  • Faster recovery
  • Usually done under local anesthesia
  • No hospitalization required
  • No interference in living routine life
  • Cost effective
  • Avoiding long-term medications
  • Avoiding surgery and complications related to it

Now many patients who fail conservative treatments with physical therapy and over the counter medication often do well with injection therapy and may avoid risky surgery. These minimally invasive therapies are performed using x-ray guidance to accurately and safely place pain relieving medications around nerves that may be inflamed.

Transforaminal Block

How many types of Transforaminal injections are there?

  • Cervical for neck
  • Thoracic for mid and upper back
  • Lumbar / sacral for low back

What is a nerve root?

Nerve roots are cable-like nerve bundles that exit the spinal cord and form nerves that travel into the arms, the thorax, the internal organs, and the legs. These nerves allow among others, movement of the arms, chest wall, and legs, but also carry sensation from these into the brain via the spinal cord. These nerve roots may become inflamed and painful due to irritation, for example, from a damaged/bulging or herniated disc or a bony spur.

What is a transforaminal injection?

A transforaminal injection is an injection of long acting drugs into the opening at the side of the spine where a nerve roots exits. This procedure is done under fluoroscopy (live X ray) guidance. This opening is known as a foramen. Sometimes these injections are referred to as root sleeve blocks, root blocks or transforaminal epidural blocks.

What is the purpose of a transforaminal injection?

The long acting drugs that is injected reduces the inflammation and swelling of spinal nerve roots and other tissues surrounding the spinal nerve root. This may in turn reduce pain, tingling and numbness and other symptoms caused by such inflammation, irritation or swelling. Also, the transforaminal injections can be used to identify a specific spinal nerve root level or levels that are the source of pain.

What happens during the procedure?

An IV will be started so that relaxation (sedatives) can be given if the patient requires, but also having prompt quick access to the patient central circulation if an emergency should occur.

It is done either with the patient on the stomach for injections. Occasionally other positions are used to optimize the X-ray view. All patients receiving sedation are monitored with ECG, blood pressure cuff and oxygen monitoring device. Patients not receiving sedation are monitored if needed. The skin of the neck or back is cleaned with antiseptic solution and sometimes numbed with local anaesthetic.

Then the injection needle is placed under X-ray guidance. Once in place, A small amount of contrast (dye) is injected to insure proper needle position. Then a small mixture of numbing medicine (anesthetic) and anti-inflammatory (steroid) is injected. this will often feel like the normal pain that the patient feels in the distribution of that particular spinal nerve root. Finally, the needle is removed and an adhesive bandage is applied.

How long does the transforaminal injection take?

The actual injection takes five to ten minutes.

What happens after the procedure?

Immediately after the procedure, the patient will move around and try to imitate something that would normally bring about their usual pain. In the beginning of treatment phase, patient is monitored for relief and side effects.

The arm(s), chest wall or leg(s) may feel weak or numb for a few hours following the procedure. This is fairly common and happens following a selective nerve root block or transforaminal epidural injection.

Instructions

The patient can eat a light meal within a few hours before the procedure.

If a patient is an insulin dependent diabetic, they must not change their normal eating pattern prior to the procedure.

Patients may take their routine medications. (i.e. high blood pressure and diabetic medications).

Post-procedure Instructions

You were given a number of medications during the procedure. These sometimes include sedatives, narcotics, local anesthetics, steroids, and other medications. Any of these drugs or procedure itself, sometimes can cause side effects, including drowsiness, temporary numbness, weakness and soreness.

What To Do After the Procedure?

Restrictions:

Rest for a few hours and use assistance if needed. Resume activity as tolerated, but do not overdo. Resume regular diet.

Do not drive or operate machinery for at least 12 hours. Do not make important decisions for 12-24 hours after treatment. Walk with assistance as long as numbness, weakness, or drowsiness is present.

Notify If You Have:

Excessive or abnormal bleeding / persistent chills or fever over 100°F If there is a major change in pain pattern or level.

How long does the effect of the medication last?

Its effect can last for several weeks to several months. In many case we can see very extended effects like few years.

How many transforaminal injections do I need to have?

If the first transforaminal injection does not relieve your symptoms within two weeks, you might be recommended to have a second injection. Similarly, if the second transforaminal injection does not completely relieve your symptoms in about a week to two weeks, you may be recommended to have a third injection. If there was no improvement after two injections, it is unlikely that a third transforaminal injection will help.

Can I have more than three transforaminal injections?

In a six-month period, most patients do not receive more than three injections. This is because the effect of the medication injected frequently lasts for six months or more. If three injections have not helped you much, it is not too likely that you will get any further benefit from more injections.

Will the transforaminal injection help me?

It is sometimes difficult to predict if the injection will help you or not. Patients who have pain radiating from the spine down into the arms or legs respond better to the injections than the patients who have only pure neck or back pain. Similarly, the patients with a recent onset of pain may respond much better than patients with longstanding pain.

What are the risks and side effects?

Generally speaking, transforaminal injections are is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain from the actual injection once the local anesthetic wears off and this pain is temporary. The other uncommon risk involve spinal puncture with headaches, infection, bleeding inside the epidural space, nerve damage and worsening of symptoms.

Who should not have a transforaminal injection?

If the patient is on a blood thinning medication, has an active infection going on, or has poorly controlled diabetes, they probably should not have the injection or at least postpone it, especially if postponing it may improve their medical condition.

Facet Joint

What is a Facet Joint Injection?

Facet Joint Injection is an injection of long lasting steroid ("cortisone") in the facet joints – which are located in the back area the spinal bony structure. These joints are actual joints with joint capsule that contains lubricating fluids.

What is the purpose of a Facet Joint Injection?

The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation / irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication (methylprednisolone).

Will the injection(s) hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "Flu shot"). There is some mild discomfort involved. However, the skin and deeper tissues are numbed with a local anesthetic using a very thin needle prior to inserting the treatment needle.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia. Sometimes patients also receive a pill given by mouth that is sedating, which makes the procedure easy to tolerate.

How is the injection performed?

It is done either with the patient lying on the stomach, or for the cervical (neck area) injections – in supine position, under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the injection is carried out. A Local Anesthetic is injected in to your skin and x-Ray machine is used to guide a small needle in to the facet joint. A contrast may be used to confirm the position of needle. The local anesthetic and / or Steroid Solution is injected. After the injection, the patient is placed on their back or on their side.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite lessened. This is due to the local anesthetic injected and may last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the fifth day or so.

What should I do after the procedure?

You should have a ride home. We advise that you should take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform normal activities as you can tolerate.

Can I go to work the next day?

Unless there are complications, you should be able to return to work the next day. The most common discomfort you may feel is a sore back.

How many injections do I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, it may be recommended to have a third injection.

Can I have more than three injections?

In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Administering more injections will increase the likelihood of side effects from cortisone.

Will the Facet Joint Injection help me?

It is very difficult to predict if the injection will indeed help you or not. Generally speaking, patients who have recent onset of pain may respond much better than patients with long standing pain.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. Risks involve infection, bleeding, worsening of symptoms, spinal block, epidural block etc. The risks related to the side effects of cortisone include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection, you should not have the injection.

Sacroiliac Joint Block

What is a Sacroiliac Joint Injection?

Sacroiliac Joint Injection is an injection of steroid and local anesthetic agent in the Sacroiliac joints – which are located in the low back area.

What is the purpose of it?

The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation/irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia.

How is the injection performed?

It is done with the patient lying on the stomach, under x-ray control. Sometimes the patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the skin may be numbed with local anaesthetic. The injection needle is then placed under X-ray guidance. Once in place, the injection is carried out. After the injection, the needle is removed and a Band Aid is applied. After the injection, you are placed on your back or on your side.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 5th day or so.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back.

How long the effect of the medication lasts?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to a few months.

How many injections do I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection

Can I have more than three injections?

In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.

Will the Sacroiliac Joint Injection help me?

It is very difficult to predict if the injection will indeed help you or not. Generally speaking, the patients who have recent onset of pain may respond much better than the ones with a long standing pain.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the injection.

Pyriformis Block

What is a Pyriformis Injection?

The piriformis muscle begins inside the pelvis and connects to the triangular-shaped bone that sits between the pelvic bones at the base of the spine known as the sacrum. The other end of the piriformis muscle connects to the greater trochanter, the bump of bone on the top side of your hip. The pyriformis muscle helps to turn the foot and leg outward. Problems in the piriformis muscle can cause problems with the sciatic nerve. This is because the sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica. A pyriformis injection involves the injection of local anaesthetic and steroids into the pyriformis muscle, temporarily reducing pain, muscle spasm and irriation of the sciatic nerve. occasionally your procedure may be performed under X Ray guidance.

What is the purpose of it?

The steroid injected reduces the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation/irritation of the joint and surrounding structures.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle into the joint.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia.

How is the injection performed?

It is done with the patient lying in comfortable position, under x-ray control. Sometimes the patients are monitored with ECG, blood pressure cuff and blood oxygen-monitoring device. The skin overlying the injection site is cleaned with antiseptic solution and then the skin may be numbed with local anesthetic. The injection needle is then placed under X-ray guidance. Once in place, the injection is carried out. After the injection, the needle is removed and a Band Aid is applied. After the injection, you are placed on your back or on your side.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore area" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 5th day or so.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is sore back.

How long the effect of the medication lasts?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 5 to 7 days and its effect can last for several days to a few months.

How many injections do I need to have?

If the first injection does not relieve your symptoms in about a week to two weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for a third injection

Can I have more than three injections?

In a six-month period, we generally do not perform more than three injections. This is because the medication injected lasts for about six months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from more injections. Also, giving more injections will increase the likelihood of side effects from cortisone.

Will the Pyriformis Injection help me?

It is very difficult to predict if the injection will indeed help you or not. Generally speaking, the patients who have recent onset of pain may respond much better than the ones with a long standing pain.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of cortisone: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin®), or if you have an active infection going on, you should not have the injection.

Trigeminal Nerve Block

What is a Trigeminal Nerve Block?

The trigeminal nerve is composed of several branches that supply sensation and motor function to the face. This important nerve has three divisions, which send several nerve branches all over the head, face and upper neck.

A Trigeminal nerve block is done for patients that are experiencing Trigeminal Neuralgia, which may be the cause of shock-like electrical pain in the face. Under guidance of a fluoroscopy x-ray, a small needle will be placed adjacent to the trigeminal nerve branch. The patient may feel a small amount of pressure or tingling as the needle approaches the nerve.

How long does the injection take?

The actual procedure takes only about 10 minutes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine) and steroids.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia. Sometimes the patients also receive a pill given by mouth that is sedating, which makes the procedure easy to tolerate.

How is the injection performed?

It is done with the patient either seated or laying on their back. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin on the face is cleaned with antiseptic solution and then the injection is carried out. Fluoroscopy (X-rays) is used to guide the needle(s) in the proper position.

What should I expect after the injection?

Immediately after the injection, you may feel your face getting warm. In addition, you may notice that your pain may be gone or quite less.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is some soreness at the injection site.

How long does the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours, days or weeks. Usually, the duration of relief gets longer after each injection.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.

Will the trigeminal nerve block help me?

It is very difficult to predict if the injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms. Patients in the advanced stages of disease may not respond adequately.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is a temporary difficulty in swallowing.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin®, Plavix®), or if you have an active infection going on near the injection site, you should not have the injection.

Maxillary Nerve Block

Coming Soon

Mandibular Nerve Block

Coming Soon

Stellate Ganglion Block

What is a Stellate Ganglion Block?

A stellate ganglion block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of Sympathetic Nervous System. The nerves are located on the either side of the voice box, in the neck.

What is the purpose of it?

The stellate ganglion block injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the upper extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, and Herpes Zoster (shingles) involving upper extremity or head and face.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine). Epinephrine (adrenaline) may be added to prolong the effects of the injection.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some discomfort involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance.

How is the injection performed?

It is done either with the patient laying flat or slightly sitting up. The chin is slightly raised. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes are also placed on your thumbs or hands. The skin in the front of the neck, next to the "voice box" is cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the injection?

Immediately after the injection, you may feel your upper extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice "a lump in the throat" as well as hoarse voice, droopy and red eye, and some nasal congestion on the side of the injection. You may also develop a headache.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck at the injection site.

How long the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours. Usually, the duration of relief gets longer after each injection.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more that 10. The response to such injections varies from patient to patient.

Will the Stellate Ganglion Injection help me?

It is very difficult to predict if a stellate ganglion blocks injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms do. Patients in the advanced stages of disease may not respond adequately.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risk involves bleeding, infection, spinal block, epidural block, and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Coumadin), or if you have an active infection going on near the injection site, you should not have the injection.

Suprascapular Nerve Block

Coming Soon

Intercostal Nerve Block

Coming Soon

Intrapleural Block

Coming Soon

Celiac Plexus Block

What is a celiac plexus block?

A celiac plexus block is an injection of local anesthetic into or around the celiac plexus of nerves that surrounds the aorta, the main artery in the abdomen. Normally these nerves control basic nerve functions. In certain conditions, these nerves can carry pain information from the gut or abdominal organ tissues back to the spinal cord and brain.

What is the purpose of a celiac plexus block?

A celiac plexus block is performed to block the celiac plexus of nerves that go various organs and parts of the abdomen. This may in turn reduce pain in the abdomen. It is done as a part of the treatment of Chronic Pancreatitis and other types of Chronic Abdominal Pain.

How long does the celiac plexus block procedure take?

The actual injection takes from 10 to 30 minutes.

What is actually injected?

The injection consists of a local anesthetic. On occasion, epinephrine, clonidine or a steroid medication may be added to prolong the effects of the celiac plexus block.

Will the celiac block hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we may numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle. Most of the patients also receive intravenous sedation that makes the procedure easier to tolerate.

Will I be "put out" for the celiac plexus block?

No. This procedure is done under local anesthesia. Most of the patients also receive some sedation, which makes the procedure easy to tolerate. The amount of sedation given generally depends upon the patient tolerance. Some patients may have enough sedation that they have amnesia and may not remember all or parts of the procedure.

How is the celiac plexus block performed?

It is done with the patient lying on stomach. The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. The celiac plexus block is performed under sterile conditions. The skin on back is cleaned with antiseptic solution and the skin is then numbed with a local anesthetic. Then X-ray is used to guide the needle or needles into the proper position along the outside of the spine. Once in place, a test dose of dye is used to confirm that the injected medication will spread in an appropriate area. If this is okay, the injection takes place gradually over several minutes. The physician will use the X-ray to evaluate the spread of the injected medication. When a sufficient area is covered, the injection will be over. When done, the needle is removed and a Band Aid is applied.

What should I expect after the celiac plexus block?

Immediately after the injection, you may feel your abdomen getting warm or feeling a bit different. In addition, you may notice that your abdominal pain may be gone or quite less. You may also notice some temporary weakness or numbness in the abdominal wall or leg, although this is actually not a desired effect of a celiac plexus block.

What should I do after the celiac plexus block?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities that you can tolerate. Some of the patients may go for immediate physical therapy.

Can I go to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the back at the injection site.

How long does the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of celiac plexus nerves may last for many more hours or days. Usually, the duration of relief gets longer after each injection.

How many celiac plexus blocks do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.

Will the celiac plexus block help me?

It is sometimes difficult to predict if the injection will indeed help you or not. The patients who present early during their illness tend to respond better than those who have had symptoms for a long time. Patients in the advanced stages of disease may not respond adequately.

What are the risks and side effects of a celiac plexus block?

This procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is temporary pain or soreness at the injection site. Uncommon risks involve bleeding, infection, spinal block, epidural block, collapses lung and injection into blood vessels and surrounding organs. Fortunately, the serious side effects and complications are uncommon.

Who should not have a celiac plexus block?

If you are allergic to any of the medications to be injected, if you are on blood thinning medications, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have the injection or at least consider postponing it if postponing would improve your overall medical condition.

Lumbar Sympathetic Block start

Coming Soon

Splanchnic Nerve Block start

Coming Soon

Hypogastric Plexus Block

What is a hypogastic plexus block?

The hypogastric plexus is a collection of nerves that is located in front of the fifth lumbar and first sacral vertebral bodies. This means that the plexus is located near the lower part of your abdomen in the upper front of your pelvis. Hypogastric plexus blocks involve the administration of a dose of pain killing medication near the region of this nerve collection. The hypogastric block usually involves a series of several injections, repeated at weekly intervals. This treatment has brought relief to many patients who suffer from pain located in the pelvic structures, to include pain located in the region of the bladder, lower intestines, as well as the uterus, ovaries and vagina in women, and the prostate and testicles in men.

How long does a hypogastric plexus block procedure take?

The procedure usually takes less than 15 minutes.

What is actually injected?

The injection typically consists of a local anesthetic and a steroid medication.

Will the injections hurt?

The hypogastric plexus block procedure involves inserting a needle through skin and tissue. So, there is some pain involved. However, we sometimes numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

Will I be "put out" for the procedure?

No. This procedure is done with a small gauge needle usually with or without any local anesthetic.

How is the joint injection performed?

You will be asked to lay down on your abdomen, with a pillow under the pelvis to help flatten out the lower lumbar spines natural curvature. Your lower back will be prepped before local anesthesia is administered at the two points of entry of the needle into your skin. When your skin is adequately anesthetized, two needles will be advanced under fluoroscopy guidance until correct needle placement is obtained. Their correct placement will also confirmed by administration of contrast dye. Once position is confirmed either a diagnostic block or a therapeutic block will be preformed. A successful hypogastric plexus block is marked by profound pain relief. Local anesthetic is usually administered for diagnostic superior hypogastric plexus block or for patients with noncancer-related pain. For patients who have a documented response to administration of local anesthetic onto the superior hypogastric plexus, a therapeutic block is preformed with administration of the neurolytic agent like phenol. Radioablation of the superior hypogastric plexus is also another treatment modality for longer-lasting pain relief.

What should I expect after the procedure?

The benefits of a hypogastric plexus block can be temporary for some people and the amount and duration of pain relief vary from person to person. Some tend to have relief for weeks where others can benefit from the block for years. Fortunately, the procedure is a low risk, nonsurgical treatment that if successful the first time, will most likely continue to provide pain relief with repeat treatments.

What should I do after the treatment?

You may want to have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is sore joint.

Will the hypogastic plexus block help me?

Expect the block to provide you with several hours of pain relief. After this time the pain will likely return. If the physicians have used steroid medication in addition to the local anesthetic, this may provide you with further pain relief after 36 to 48 hours. Sometimes, this block is performed for diagnostic reasons. This means that your physicians have chosen to do the hypogastric plexus blocks in order to determine a possible cause for your pain. In this instance, you may or may not experience any pain relief.

What are the risks and side effects hypogastric plexus blocks?

The most common side effect from this procedure is a sore back in the region where the blocks were performed. There is a very small chance of the needle puncturing a blood vessel. This potentially could lead to blood clot formation in your pelvis; however, this is extremely rare and your physician will take extra precautions to attempt to avoid this complication. There is also a very rare chance of injury to either the kidney or urethras. The urethras are the structure that connects your kidneys to your bladder. These risks are, again, extremely small and are even less likely when the procedure is performed under x-ray guidance.

Who should not have a hypogastric plexus block?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on you should not have this procedure or at least consider postponing it if postponing would improve your overall medical condition.

Ganglion Of Impar Block

What is a Ganglion Impar Block?

A ganglion impar block is a procedure used to reduce some of the symptoms of chronic pelvic or rectal pain by blocking nerve impulses. The ganglion impar is a structure located at the level of the coccyx. The nerve block can be diagnostic or therapeutic. One of three things will happen:

  • The pain does not go away, which means that it is probably not coming from the nerves at the site of the injection. This is of diagnostic value.
  • The pain goes away and stays away for a few hours, but then returns. In this case, the block is also of diagnostic value, as it means the pain is probably coming from the nerves at the level of the injection, but the steroid was of no benefit.
  • The pain goes away after the block but returns later that day and then improves over the next few days. This means that the block was of therapeutic value, as both the anesthetic agent and the steroid had an effect on the pain.

How long does the procedure take?

The entire procedure should take 15 minutes or less.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine) and steroid medication.

Will the injection hurt?

The procedure involves inserting a needle through skin and some deeper tissues (like a "Flu shot"). Therefore, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia.

How is the injection performed?

You will be lying on your stomach on a narrow table. Your back will be cleaned with iodine and sterilely draped. The doctor will numb your skin with a small needle, which will sting just a bit. Next, the doctor will use an X-ray machine (fluoroscope) to guide the needle into the correct spot. Local anesthetic and steroid are then injected through the needle, and the needle is removed. Your skin will be cleaned and a bandage may be applied (and removed the next day). Your pain may improve immediately after the injection due to the local anesthetic.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This may last only for a few hours. Your pain will return and you may be sore for a day or two. This is due to the mechanical process of needle insertion. It is very important for you to keep a track of your pain and stiffness for the next hours to days following injections.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform your usual activities as tolerated.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is a sore back.

How long does the effect of the medication last?

The immediate effect is from the local anesthetic injected. Depending upon the medication injected, it can last from 2 hours to 8 hours. Your pain relief may last a lot longer as a result of treating the pain and the associated spasm.

Will the procedure help me?

The location, size and shape of the ganglion impar nerve varies in different people, and because of this, a possible risk is an ineffective block. If no relief is obtained from the initial approach (usually transsacrococcygeal), the physician will likely elect to try another approach that is better suited to the patients anatomy.

What are the risks and side effects?

The risk for this procedure is very low. In fact in current published literature, there are no major complications reported from this block. Despite these published statistics, the theoretical risk of this procedure exists and includes: if the needle is misplaced you can experience bleeding, especially into your retroperitoneal space, nerve injury and/or paralysis, puncture of surrounding organs (including rectum) and puncture of adjacent vessels. Risks secondary to the spread of the anesthetic include drug allergy and seizure (if the medication is injected into a blood vessel). Also with any penetration of skin and soft tissues, the risk of infection always exists.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Plavix, Coumadin®), or if you have an active infection going on, you should not have the injection.

Knee Joint / Shoulder Joint Injection

What is a joint injection?

A joint injection is an injection of a steroid or other medication ( Lubricating Agent) into a joint; any place two bones move against each other and are surrounded by a joint capsule.

What is the purpose of a joint injection?

The medication injected, usually a steroid, is meant to reduce the inflammation and/or swelling of tissue in the joint space. This may in turn reduce pain, and other symptoms caused by inflammation or irritation of the joint and surrounding structures.

How long does the joint injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection typically consists of a local anesthetic and a steroid medication.

Will the joint injection hurt?

The procedure involves inserting a needle through skin and deeper tissues. So, there is some pain involved. However, we sometimes numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

Will I be "put out" for the joint injection?

No. This procedure is done with a small gauge needle usually with or without any local anesthetic.

How is the joint injection performed?

It is done with the patient in whatever position allows the best access into the joint. Shoulders, elbows, wrists, fingers and knees are often injected with the patient sitting. Hips, knees, ankles and toes are often injected with the patient lying down. The skin is cleaned with antiseptic solution and then the injection is carried out. A band-aid is usually applied.

What should I expect after the joint injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a sore joint for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation from the steroid itself. You should start noticing pain relief starting the 3rd to 5th day or so.

What should I do after the joint injection?

You may want to have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to work the next day. The most common thing you may feel is sore joint.

How long does the effect of the medication last?

The immediate effect is usually from the local anesthetic injected. This wears off in a few hours. The cortisone starts working in about 3 to 5 days and its effect can last for several days to a few months.

How many joint injections do I need to have?

If the first injection does not relieve your symptoms in two to three weeks, you may be recommended to have one more injection. If you respond to the injections and still have residual pain, you may be recommended for further injections on an as needed basis, depending on the underlying condition of the joint.

Can I have more than three joint injections?

In a six to twelve month period, we generally prefer not to perform more than three injections. This is because the medication injected is meant to last for several weeks to several months. If three injections have not helped you much, it is very unlikely that you will get any further benefit from an increasing number of injections. Also, giving more injections will increase the likelihood of side effects from the steroids. If the injections are not working, stronger consider may need to be given to orthopedic surgery.

Will the joint injections help me?

It is sometimes difficult to predict if the injection will indeed help you or not. The patients who have recent onset of pain or milder pain may respond much better than the ones with a longstanding pain or severe pain.

What are the risks and side effects of joint injections?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms etc. The other risks are related to the side effects of steroids: These include weight gain, increase in blood sugar (mainly in diabetics), water retention, suppression of body's own natural production of cortisone etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have a joint injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have a joint injection or at least consider postponing it if postponing would improve your overall medical condition.

Trigger Point Injection

What is a Trigger Point Injection?

A Trigger Point Injection (TPI) is an injection that will help diagnose and treat certain chronic pain conditions where muscle sensitivity and pain exist.

How long does the injection take?

The actual injection takes only a few minutes for most patients.

What is actually injected?

The injection consists of a mixture of local anesthetic (like lidocaine or bupivacaine) and the steroid medication.

Will the injection hurt?

The procedure involves inserting a needle through skin and possibly some deeper tissues. So, there is some discomfort involved. However, we numb the skin and tissue with a local anesthetic using a very thin needle prior to inserting the needle into the joint.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia.

How is the injection performed?

The procedure includs injecting the skin with a local anesthetic. You may feel a stinging and burning sensation. When the tip of the needle touches the trigger point, you may feel a brief increase in your pain. This pain is a good sign that the medicine is in the correct spot; the pain usually goes away quickly. The actual time it take for your doctor to complete the procedure may be different for each patient.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This will last only for a few hours. Your pain will return and you may have a "sore back" for a day or two. This is due to the mechanical process of needle insertion as well as initial irritation form the steroid itself. You should start noticing pain relief starting the 5th day or so.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is some soreness at the affected area.

How long the effect of the medication lasts?

The length of pain relief varies from person to person. In most cases, the pain may be lessened for a few days up to a few months. Your doctor may recommend TPIs as well as other types of pain management as part of your treatment plan.

How many injections do I need to have?

Sometimes your doctor will prescribe a series of injections. These injections are done several weeks apart. After this series, your doctor can determine how the injections are helping you. If the second or third injection does not help, then TPIs most likely will not help your pain

Will the Trigger Point Injection help me?

It is very difficult to predict if the injection will indeed help you or not. Your pain may go away after the injection and never come back. Sometimes the injection only helps to lessen pain for a short time. In this case, a second injection may be helpful.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. Very rarely, if the injection is done in the chest wall or low in the neck, the needle may puncture the lung. This would cause chest pain and difficulty breathing. Also, the needle may hit a nerve that could cause pain.

Trigger point injections do have some associated side effects including: the injection area may be sore for several days, bruising in the area of injection, muscle stiffness due to muscle spasm. If this is a problem, you might try acetaminophen or aspirin. Also, try applying a cold pack. If it doesn't work, try warm, moist heat, and then gently stretch the muscle in the affected area to relieve muscle stiffness.

Who should not have this injection?

You should not have this injection if you are: thinking of becoming pregnant, or are currently pregnant or breastfeeding. If you have severe allergic reaction to local anesthetics. If you are taking blood thinning medicine like coumadin (Warfarin), clopidogrel (Plavix), aspirin/dipyridamole (Agrrenox), Enoxaparin (Lovenox), Fondaparinux (Arixtra) or heparin. You will need to stop taking them before the procedure. Discuss this with your doctor or cardiologist in order to weigh the risks and benefits of stopping these medicines. It is OK to take Tylenol for other pain like arthritis, pain from previous operations, abdominal pain and headaches.

Cancer Pain

Coming Soon

Median Branch Block

What is a Medial Branch Block?

Facet Joints are innervated by nerves called medial branch nerves. These nerves carry the pain signals at the facet joints to the spinal cord and the signals eventually reach the brain, where the pain is noticed.

What is the purpose of it?

If the nerves are blocked or numbed, they will not be able to carry pain sensation to the spinal cord. It is like temporarily cutting off "wires". Therefore, if the pain is due to facet joint arthritis, you should have relief from pain and stiffness. Once it is determined that the pain is indeed due to facet joint disease, we can use a procedure called "Radio-Frequency Lesioning" and prevent the conduction of pain information for several weeks to months. So, a medial branch block is a temporary and diagnostic procedure.

How long does the injection take?

The actual injection takes only a few minutes. The more nerves to be blocked, the more time it takes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine).

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "Flu shot"). Therefore, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

Will I be "put out" for this procedure?

It would be your decision. The procedure can be done with or without mild sedation. The outcome is not altered with either choice.

How is the injection performed?

It is done either with the patient lying on the stomach. The needles are guided to the nerves under x-ray guidance. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out. A Local Anesthetic is injected in to your skin and x-Ray machine is used to guide a small needle on to the medial Branch Nerve. A contrast may be used to confirm the position of needle. The local anesthetic and / or Steroid Solution is injected.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This sensation is due to the local anesthetic injected. This pain relief may last only for a few hours. Your pain will return and you may have a "sore back or neck" for a day or two. This is due to the mechanical process of needle insertion. It is very important for you to keep a track of your pain and stiffness for the next hours to days following injections.

What should I do after the procedure?

You should have a ride home if the procedure is completed under sedation. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform your usual activities as tolerated.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is a sore back.

How long does the effect of the medication last?

The immediate effect is from the local anesthetic injected. Depending upon the medication injected, it can last from 2 hours to 8 hours. Your pain relief may last a lot longer as a result of treating the pain and the associated spasm. Of course, if the facet joints are not the source of your pain, you may not have much relief.

How many injections do I need to have?

Usually one session is enough to determine if the facet joints are the most likely source of your pain or not. However, the "placebo response" can be as high as 30 to 40 % and some patients may be recommended to have repeated diagnostic injections. In addition, "False Positive" responses can occur. A second block can confirm the outcome.

Will the procedure help me?

If the pain is originating mostly from the facet joints, you should benefit from this procedure on a temporary basis. Please remember that these are diagnostic injections only and last only for a few hours. These are done to determine if the pain is coming from the facet joints or not, and if the pain is coming from the facet joints, we will recommend "Radio-Frequency Lesioning" – which will ablate or "numb" the same nerves for many weeks to months.

What are the risks and side effects?

Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risks involve, infection, bleeding, worsening of symptoms, spinal block, epidural block etc. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Plavix, Coumadin®, warfarin, pradaxa), or if you have an active infection going on, you should not have the injection.

Epidural Steroid Injections

What are Epidural Steroid Injections?

Epidural steroid injections (ESIs) are a frequently used treatment for chronic pain syndromes. A common characteristic among the syndromes treated with ESIs is a pain described as "radicular pain". The word radicular means root and typically refers to an irritated nerve root "Radiculitis" or weakness associated with an affected nerve root "Radiculopath".

How long does the injection take?

The actual injection takes only a few minutes. The more nerves to be blocked, the more time it takes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine) and steroid Medication.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues (like a "Flu shot"). Therefore, there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the needle into the joint.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia.

How is the injection performed?

It is done either with the patient lying on the stomach for the upper and low back pain, or supine (laying on the back) for the upper cervical (neck area), under x-ray control. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. The skin in the back is cleaned with antiseptic solution and then the injection is carried out.

What should I expect after the injection?

Immediately after the injection, you may feel that your pain may be gone or quite less. This is due to the local anesthetic injected. This may last only for a few hours. Your pain will return and you may have a "sore back or neck" for a day or two. This is due to the mechanical process of needle insertion. It is very important for you to keep a track of your pain and stiffness for the next hours to days following injections.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform your usual activities as tolerated.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is a sore back.

How long does the effect of the medication last?

The immediate effect is from the local anesthetic injected. Depending upon the medication injected, it can last from 2 hours to 8 hours. Your pain relief may last a lot longer as a result of treating the pain and the associated spasm. Of course, if the facet joints are not the source of your pain, you may not have much relief.

How many injections do I need to have?

Often these procedures are done in sets of three.

Will the procedure help me?

If the pain is originating mostly from the facet joints, you should benefit from this procedure on a temporary basis. Some do get a "placebo response" and others may get a "False-Positive" response. Please remember that these are diagnostic injections only and last only for a few hours. These are done to determine if the pain is coming from the facet joints or not, and if the pain is coming from the facet joints, we will recommend "Radio-Frequency Lesioning" – which will "numb" the same nerves for many weeks to months. Some patients may develop longer pain relief (days to weeks) as a result of breaking the cycle of pain and spasm in the area.

What are the risks and side effects?

Epidural Steroid Injections (ESIs) are considered an appropriate non-surgical treatment for many patients who suffer from back and neck pain. Although ESIs are considered safe and are one of the most commonly performed procedures in the world, there are risks associated with the procedure. The major risks associated with this procedure involve bleeding, infection, post-dural puncture headache, and nerve damage. The other risks of the Epidural Steroid Injections may be directly related to the medications injected. Some of the potential side effects of corticosteroids include elevated blood sugars, weight gain, arthritis, stomach ulcers, and transient decrease in immune system function. All patients before receiving an ESI should be assessed by their physician about risk assessment for the procedure.

Patients with an allergy to any anesthetic, are on blood thinning medications, have an active infection, or are pregnant should consult with your pain physician before receiving the procedure.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on a blood thinning medication (e.g. Plavix, Coumadin®), or if you have an active infection going on, you should not have the injection.

Peripheral Nerve Block

What is peripheral nerve block?

A "nerve block" is a technique of injecting numbing medicine (also called local anesthetic) around a group of nerves. This causes a specific area of the body to be numb. Nerve blocks have become an important therapy in the treatment of certain types of acute and chronic pain, particularly where management with medications is unsuccessful. With nerve blocks, medication consisting of an anesthetic and a steroid is injected directly into a nerve to reduce inflammation and block the transmission of pain signals to the brain. A sympathetic nerve block is one that is performed to determine if there is damage to the sympathetic nerve chain. This is a network of nerves extending the length of the spine. These nerves control some of the involuntary functions of the body, such as opening and narrowing blood vessels.

How long is the peripheral nerve block procedure?

The actual injection takes from 10 to 30 minutes.

What is actually injected?

The injection consists of a local anesthetic. On occasion, epinephrine, clonidine or a steroid medication may be added to prolong the effects of the peripheral nerve block.

Will the injection hurt?

Sedation is often given during the nerve block procedure to help decrease any discomfort that you may feel.

Will I be "put out" for the peripheral nerve block procedure?

You may be given sedation or general anesthesia during the actual procedure (or occasionally remain awake). In any case, you will not see or feel the actual procedure. Your anesthesia provider will discuss the options with you prior to surgery to determine the best plan.

How is the peripheral nerve block performed?

The patients are monitored with EKG, blood pressure cuff and an oxygen-monitoring device. The peripheral nerve block is performed under sterile conditions. The skin on neck or extremity is cleaned with antiseptic solution and the skin is then numbed with a local anesthetic. Then X-ray is used to guide the needle or needles into the proper position. Once in place, a test dose of dye is used to confirm that the injected medication will spread in an appropriate area. If this is okay, the injection takes place gradually over several minutes. The physician will use the X-ray to evaluate the spread of the injected medication. When a sufficient area is covered, the injection will be over. When done, the needle is removed and a bandage is applied.

What should I expect after the peripheral nerve block?

Immediately after the injection, you may feel your arm or leg getting warm or feeling a bit different. In addition, you may notice that your pain may be gone or quite less.

What should I do after the peripheral nerve block procedure ?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities that you can tolerate. Some of the patients may go for immediate physical therapy.

Can I go to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the back at the injection site.

How long does the effect of the medication last?

Depending on the medication injected, the effects of the block can last 8 to 24 hours.

What are the risks and side effects of a peripheral nerve block?

Each type of nerve block has unique benefits and risks. Some risks include bleeding, infection, injury to nerves, and an adverse reaction to the local anesthetic medication. Your anesthesia provider will review your medical history and planned procedure and discuss the benefits and risks of a nerve block. The anesthesia provider will answer any questions you may have.

Make sure to tell your anesthesia provider if you have any type of preexisting pain, numbness or weakness or preexisting nerve injury. It is also important to let your anesthesia provider know if you have any respiratory (lung, breathing) problems.

Who should not have a peripheral nerve block?

If you are allergic to any of the medications to be injected, if you are on blood thinning medications, if you have an active infection going on, or if you have poorly controlled diabetes or heart disease, you should not have the injection or at least consider postponing it if postponing would improve your overall medical condition.

Sympathetic Nerve Block

What is a Sympathetic Nerve Block?

Sympathetic Nerve Block is an injection of local anesthetic in the "sympathetic nerve tissue" – the nerves which are a part of the Sympathetic Nervous System. The nerves are located in the back, on the either side of spine.

What is the purpose of a sympathetic nerve block?

The injection blocks the Sympathetic Nerves. This may in turn reduce pain, swelling, color, and sweating changes in the lower extremity and may improve mobility. It is done as a part of the treatment of Reflex Sympathetic Dystrophy (RSD), Sympathetic Maintained Pain, Complex Regional Pain Syndrome, Herpes Zoster (shingles) involving lower extremity, vascular insufficiency and peripheral neuropathy.

How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic (like lidocaine or bupivacaine) and steroids.

Will the injection hurt?

The procedure involves inserting a needle through skin and deeper tissues , so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle before inserting the actual block needle.

Will I be "put out" for this procedure?

No. This procedure is done under local anesthesia. Sometimes the patients also receive a pill given by mouth that is sedating, which makes the procedure easy to tolerate.

How is the injection performed?

It is done with the patient lying on the stomach with pillows under the hips. The patients are monitored with EKG, blood pressure cuff and blood oxygen-monitoring device. Temperature sensing probes may also be placed on your feet. The skin on the back is cleaned with antiseptic solution and then the injection is carried out. Fluoroscopy (X-rays) is used to guide the needle(s) in the proper position.

What should I expect after the injection?

Immediately after the injection, you may feel your lower extremity getting warm. In addition, you may notice that your pain may be gone or quite less. You may also notice some weakness and/or numbness in the leg which is only temporary.

What should I do after the procedure?

You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. Perform the activities as tolerated by you. Some of the patients may go for immediate physical therapy.

Can I go to work to work the next day?

Unless there are complications, you should be able to return to your work the next day. The most common thing you may feel is soreness in the neck at the injection site.

How long does the effect of the medication last?

The local anesthetic wears off in a few hours. However, the blockade of sympathetic nerves may last for many more hours, days or weeks. Usually, the duration of relief gets longer after each injection.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections. Usually, a series of such injections is needed to treat the problem. Some may need only 2 to 4 and some may need more than 10. The response to such injections varies from patient to patient.

Will the Sympathetic Nerve Block help me?

It is very difficult to predict if the injection(s) will indeed help you or not. The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms. Patients in the advanced stages of disease may not respond adequately.

What are the risks and side effects?

This procedure is safe. However, with any procedure there are risks, side effects, and possibility of complications. The most common side effect is pain – which is temporary. The other risk involves bleeding, infection, spinal block, epidural block, and injection of the local anesthetics directly into blood vessels (seizure, Arrhythmias) and surrounding organs. Fortunately, the serious side effects and complications are uncommon.

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin®, Plavix®), or if you have an active infection going on near the injection site, you should not have the injection.