What is a Medial Branch Block?

• Facet joints are small joints between the vertebrae (bones of the spine). If injured, these joints can become a source of persistent neck, upper limb, lower limb or back pain.
• A medial branch block involves the injection of local anaesthetic, with or without corticosteroid, onto the nerves that supply the facet joints (medial branches). This may also be known as a facet joint injection or a dorsal ramus block.
• If local anaesthetic is used alone, this is a diagnostic medial branch block and any pain relief obtained is temporary. This is performed to establish if and which facet joints are the source of your pain.
• If a combination of medications is used, it is hoped that you will obtain pain relief for up to 6 months.
• A medial branch block is always performed using an X-ray machine in the day surgery.

Prior to the Procedure

• All blood thinning products (except aspirin) must be stopped prior to your procedure. You will be advised by letter when to stop taking these medications at the time that your admission date is arranged.
• You are able to take your other regular medications with a sip of water on the morning of your procedure.
• If you are an insulin dependent diabetic you will always be at the beginning of the list. Please bring your insulin with you and it will be given to you following your procedure.
• Hamilton Day Surgery Centre staff will advise you of your fasting and admission times.
• You must not have anything to eat, drink, smoke or chew prior to your procedure.
• You will need to organise someone to drive you home after the procedure as you will not be able to drive for 24 hours after your procedure.

What Will Happen?

1. You will be admitted to the day surgery by a nurse and you will be asked to change into a gown.
2. The anaesthetist will speak with you and place a cannula (plastic needle) into a vein in your hand.
3. In the procedure room, you will be assisted into position on the procedure table. You will either be lying on your abdomen with a pillow under your hips and abdomen, or for cervical procedures, you will be on your back with a special pillow under your head.
4. The anaesthetist will give you some sedation into your vein.
5. An X-ray machine will be used to determine where the doctor will place the needle for your procedure. This will be marked with a pen.
6. Local anaesthetic +/- corticosteroid will be injected onto the nerves (medial branches) that supply the facet joint once the correct placement has been established with the use of X-ray contrast (Omnipaque). The procedure will take approximately 10 minutes to complete.
7. After the procedure, you will be placed on a trolley and taken to recovery. You will remain in recovery for 30 minutes if you are undergoing diagnostic medial branch blocks for dynamic pain scoring, and will be asked to score your pain every 15 minutes for the next 2 hours.
8. You will be seen by the doctor prior to discharge.
9. After having something to eat and drink, you will be discharged with a carer.

Post Procedure

• Gentle activity and rest is recommended in the first 24 hours following the procedure. You may then return to normal activity.
• The local anaesthetic will wear off 12 to 18 hours following your procedure.
• If corticosteroid is used it may take up to 48 hours to start working. During this time there may be a window of increased discomfort or pain.
• You may obtain up to 6 months of pain relief.
• A nurse from HPC will telephone you 24 to 48 hours following your procedure to check on your progress and organise a follow-up appointment.

If you require further explanation of the procedure, please contact Hunter Pain Specialists nursing staff on (02) 4985 1800.