Medial Branch Nerve Blocks Risks, Complications, and Follow-Up Results

By: Ray M. Baker, MD

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Medial branch nerve block results and follow-up

The medial branch nerve block is designed to interrupt the pain signal being carried by the medial branch nerves that supply a specific facet joint. Because of this, patients may feel complete or partial pain relief during the first 6 to 12 hours after an injection. They may also feel no pain relief during this time (anesthetic phase). If the area is uncomfortable in the first two to three days after the injection, applying ice or a cold pack to the general area of the injection site will typically provide pain relief.

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Patients may continue to take their regular medications after the procedure, with the exception of limiting pain medicine within the first four to six hours after the injection so that the diagnostic information obtained is accurate.

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On the day after the procedure, patients may return to their regular activities. When the pain is improved, it is advisable to start regular exercise and activities in moderation. Even if the pain relief is significant, it is still important to gradually increase activities over one to two weeks to avoid recurrence of pain.

Depending on the amount of pain relief the patient has during the first 6 to 12 hours after the injection, the patient may be a candidate for a radiofrequency neurotomy procedure to try and provide longer term pain relief. Generally, a patient must report at least 80% improvement in their pain during the first 6 to 12 hours after the injection to be considered a candidate for radiofrequency neurotomy.

Potential risks and complications of medial branch nerve blocks

As with all invasive medical procedures, there are potential risks and complications associated with medial branch blocks. However, in general the risk is low, and complications are rare. Potential risks and or complications that may occur from a medial branch injection include:

Allergic reaction. Usually an allergy to x-ray contrast and rarely to local anesthetic.
Bleeding. A rare complication, bleeding is more common for patients with underlying bleeding disorders.
Infection. Minor infections occur in less than 1% to 2% of all injections. Severe infections are rare, occurring in 0.01% to 0.1% of injections.
Worsening of pain symptoms.
Discomfort at the point of the injection.
Nerve or spinal cord damage or paralysis. While very rare, damage can occur from direct trauma from the needle, or secondarily from infection, bleeding resulting in compression, or injection into an artery causing blockage.

Patients who are on a blood thinning medication (such as Coumadin^®), or have an active infection, may not be able to have this procedure, and these situations should be discussed with the treating physician. Patients should also let their doctor know of any allergies they have to medications that may be used for the procedure.