PainDoctorUSA

Nerve Block

Article
Brain & Nerve
Radiology Procedures
Contributed byKrish Tangella MD, MBAJan 18, 2019

Background Information:

What are the other Names for the Procedure?

  • Nerve Block for Pain
  • Numbing of Nerve Procedure

What is Nerve Block radiology procedure? (General Explanation)

  • Nerve Block is a procedure to basically inject a local anesthetic or anti-inflammatory injection to numb specific nerves or a nerve bundle to treat pain
  • Imaging guidance, such as fluoroscopy or CT scan, may be used to determine the exact location of needle placement

What part of the Body does the Procedure involve?

Several parts of body, such as the spine, buttocks, neck, hips, legs, or arms, may be involved depending upon the area of pain.

Why is the Nerve Block radiology procedure Performed?

Following are the common uses of Nerve Blocks:

  • To relieve acute or chronic pain due to nerve pain in various regions of the body including the spine, buttocks, neck, legs, and arms
  • To determine the source of pain by monitoring the results of Nerve Block
  • Nerve Blocks are also done before surgeries, such as knee replacement or hip replacement, to prevent postoperative pain

What is the Equipment used? (Description of Equipment)

The following equipment may be used in a Nerve Block procedure:

  • Injection syringe filled with anti-inflammatory or anesthetic medication
  • Fluoroscopy (for image guidance)
    • An X-ray machine is used in fluoroscopy
    • Fluoroscopy basically converts x-ray images in real-time to video images          
  • CT scan (for image guidance)
    • The CT scanner looks like a big box with a hole inside
    • The examination table on which the patient lies down, which slides in and out of the hole
    • X-ray tube and electronic X-ray detectors that rotate around the patient
    • Images are taken from a computer

What are the Recent Advances in the Procedure?

There have been no recent advances in the Nerve Block procedure.

What is the Cost of performing the Nerve Block radiology procedure?

The cost of Nerve Block procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Nerve Block procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25545781 (accessed on 07/20/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25541522 (accessed on 07/20/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25539050 (accessed on 07/20/2015)

Prior to Nerve Block radiology procedure:

How does the Nerve Block radiology procedure work?

  • An anti-inflammatory or anesthetic medication is given during the Nerve Block procedure that covers the nerve causing the pain, depressing the pain receptors within the nerve
  • The effect of medication is immediate and most of the patients feel the difference right away
  • The relief provided by Nerve Blocks is temporary and once the medication effect wears off, the pain may return. Thus, the patient may have to go through several rounds of Nerve Blocks in order to obtain more relief

How is the Nerve Block radiology procedure Performed?

The Nerve Block procedure is performed on an outpatient basis.

  • The patient is positioned on the examination table in the required position, depending upon the Nerve Block to be performed
  • Fluoroscopy or CT scan is used to identify the spot where the needle would be inserted
  • Once the location of needle insertion is determined, the site is cleaned with an antiseptic solution
  • The needle is inserted into the specific location and medication is delivered
  • After the needle is removed, patients may be asked to wait for 15-20 minutes in the recovery area, to observe the effect of medications and any side effects the patient may develop

Where is the Procedure Performed?

Nerve Block procedure is performed as an outpatient procedure.

Who Performs the Procedure?

Nerve Blocks are usually performed by an anesthesiologist or pain management specialist.

How long will the Procedure take?

The Nerve Block procedure takes only a few minutes to perform; however, there may be wait and preparation times involved.

Who interprets the Result?

An anesthesiologist or a pain management specialist interprets the results of the procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Nerve Block procedure:

  • The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
  • Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
  • Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
  • Some patients may be asked to temporarily discontinue their anticoagulation medications to avoid the risk of bleeding
  • It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
  • Women should notify the physician if they are pregnant or breastfeeding their child; as many such procedures may not be performed on pregnant women
  • Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
  • The patient may be asked to avoid eating or drinking several hours before the test
  • It is recommended to notify the physician about any implants or metal objects in the body, such as a pacemaker, nerve simulators, surgical staples, or artificial heart valves, braces, or dyed tattoos, as they may interfere with the imaging, in some cases

What is the Consent Process before the Procedure?

A physician will request your consent for the Nerve Block procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Nerve Block procedure:

  • Nerve Blocks help provide immediate relief from acute or chronic pain
  • It can also help identify the source of pain by observing how Nerve Block affects the body

Following are the risks of the Nerve Block procedure:

  • Bleeding
  • Infection at the site of injection
  • Damage to the nerve by the needle
  • In rare cases, accidental delivery of medication into the bloodstream
  • Exposure to radiation if imaging tool, such as CT or fluoroscopy, is used during the procedure

What are the Limitations of the Nerve Block radiology procedure?

Following are the limitations of the Nerve Block procedure:

  • It only provides a temporary pain relief
  • The procedure may not yield successful results in certain patient populations; a different approach may be required in such cases
  • The patient may need more than one round of ‘Nerve Blocks’ for longer pain relief
  • If the medication is not delivered to the correct spot, the procedure will be ineffective

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

  • What is a Nerve Block procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed?
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • What are the possible side effects from the procedure? How can I minimize these side effects?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any lifestyle restrictions or modifications required after the procedure is performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
  • Is there any medication that needs to be taken for life after the procedure?
  • What are the costs involved?

During the Nerve Block radiology procedure:

What is to be expected during the Nerve Block radiology procedure?

The following may be expected during the Nerve Block procedure:

  • Nerve Blocks is a minimally-invasive procedure
  • Patient feels a minor sting when the needle is inserted
  • Patient may feel a pressure like discomfort when medication is injected
  • Patients are asked to notify the physician, if they feel a sudden jolt of pain or sharp pain with radiation, as it may indicate that the needle is too close to the nerve and it may have to be repositioned
  • Once the medication is injected around the nerve, the patient feels pain relief almost immediately, in most of the cases

What kind of Anesthesia is given, during the Procedure?

Anesthesia is rarely used during the Nerve Block procedure.

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally invasive one, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Nerve Block radiology procedure?

Following are the possible risks of Nerve Block procedure:

  • Sometimes, the nerve may be damaged through improper needle insertion
  • Delivery of medication into the blood stream by accident

What Post-Operative Care is needed at the Healthcare Facility after the Nerve Block radiology procedure?

No specific post-operative care is needed at the healthcare facility after the procedure.

After the Nerve Block radiology procedure:

What is to be expected after the Nerve Block radiology procedure?

Patients are asked to wait for 15-20 minutes in the recovery area to observe the effect of medications and any side effects the patient may develop after the Nerve Block procedure.

When do you need to call your Physician?

Patients need to call their physician in the following cases:

  • If high fever, redness, warmth, or inflammation around the injection site develops
  • The patient develops numbness after the Nerve Block

What Post-Operative Care is needed at Home after the Nerve Block radiology procedure?

No specific post-operative care is needed at home after the procedure.

How long does it normally take to fully recover, from the Procedure?

  • No recovery time is needed after a Nerve Block procedure
  • Patients may resume their normal activities immediately after the procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Nerve Block procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Nerve Block radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The hospital, where the procedure is performed
  • Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Nerve Block procedure is performed.

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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