What is a facet joint block (or medial branch block)?

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A facet joint block is an injection of local anesthetic (numbing medicine) into one or more of the small joints located along the side of each vertebrae on both sides of the spine. Multiple injections may be performed, depending upon how many joints are involved. Facet joint blocks are typically requested for patients who have pain primarily in their neck or back as a result of arthritic changes in the facet joints or for patients who have mechanical neck or back pain. A facet joint block may be diagnostic (a test to see if your pain is coming from this area) and/or therapeutic (to relieve your pain).

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Note: The procedure cannot be performed if you have an active infection, flu, cold, fever, very high blood pressure or if you are on blood thinners. Please make your doctor aware of any of these conditions. This is for your safety!

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How do I prepare for the procedure?

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No solid food or fluids after midnight prior to the procedure unless directed otherwise. You may take your medications with a small amount of water. Diabetics should not take their medication for diabetes until after the procedure is complete. Please check your blood sugar at home before arriving. If you are taking any blood thinners such as Coumadin, Xarelto, Eliquis, Plavix, or any others, these medications must be discontinued well before the procedure. You will be directed by our staff as to when you should stop this medication. Please make your Pain Management doctor aware that you are taking a blood thinner and contact your primary care physician or prescribing physician before stopping this medication.

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What are the risks of the procedure?

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As with most procedures, there is a remote risk of bleeding, infection, nerve injury, or allergic reaction to the medications used. Other short-term side effects may occur. If local anesthetic spreads to nearby nerves, you may have weakness or numbness that can last for several hours. If this happens, you may have to be observed until it resolves. You may have increased pain for a few days after the injections, including localized pain at the injection site.

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How much will the injection hurt?

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Most people say the stinging/burning of the numbing medicine is the most uncomfortable part of the procedure (this lasts only a few seconds); however, each person’s response to any procedure will differ.

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What happens during the actual procedure?

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The procedure will be done in the fluoroscopy (X-ray) room with you lying on your stomach. An intravenous (IV) line may be started in your hand or arm to give fluids and/or medication to help you to relax. Your neck or back will be thoroughly cleansed with an antiseptic soap. Sterile drapes will be placed over your lower back. Your back will be numbed with injections of local anesthetic using a very small needle. You may feel a brief stinging or burning sensation, which will go away in about 15 seconds. Using X-ray guidance, longer needles are then advanced into the facet joints along the spine. Once the needles are in the proper location, a local anesthetic medication (with or without steroids) will be injected, and the needles will be removed. Your skin will be cleaned again, and Band-Aids will be applied. You will be moved to the recovery area, where your vital signs will be monitored for an appropriate time, usually about 20-30 minutes. You will be given verbal and written discharge instructions, and you will be able to leave with your driver after your doctor authorizes discharge.

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How will I feel after the injection?

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Your back pain may be improved immediately after the injection as a result of the local anesthetic. It is important to keep track of how you feel for the rest of the day. We encourage you to move around and do your usual activities, provided they are not too strenuous. It is important that you keep track of the amount of pain relief you receive as well as how long the pain relief lasts. Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three or four times a day may help alleviate this. We would like you to hold off taking pain medication the day of procedure so you will be able to accurately see how much of your pain is relieved by the procedure alone. Your feedback about pain relief after the procedure will guide us in deciding the next step in your treatment.

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Will I have any restrictions on the day of the procedure?

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You may not drive for the remainder of the day after your procedure. A responsible adult (over 18 years old) must be present to drive you home or to go with you in a taxi. The procedure will be cancelled if you don't have a responsible adult with you! This is for your safety. No heat is to be used on the injected area for the remainder of the day. No tub bath, shower or soaking in water (i.e., pool, hot tub, etc.) for the remainder of the day. You may resume normal diet and medications after the procedure unless told otherwise by your doctor.

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When Should I Call the Pain Management Center?

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We would like to see you in follow up 1-2 weeks after the procedure. Specifically, we would like to know if you experienced pain relief (if so, how long did it last), your current pain score, and if you are experiencing any problems. If you experience severe pain, new numbness or weakness of your legs, a temperature of 100.5 or greater, or signs of infection in the area of the injection (redness, swelling, heat, discharge), you should call our office immediately at 702-982-1300.