Non-Spinal Nerve Block

Your doctor may recommend a non-spinal nerve block for two purposes:

• Diagnosing the source of pain. Your doctor will inject anesthetic medicine around a specific nerve or group of nerves. If it relieves your pain, then that nerve is the source of your pain. If it does not relieve your pain, then your doctor will look for another source.

• Treating pain. Your doctor can inject anesthetic or anti-inflammatory medicine to relieve pain and reduce swelling. This includes corticosteroids. Your doctor can also destroy the nerve fibers that are causing pain with a drug, called a chemical neurolytic, or with an electrical current, called radiofrequency ablation.

In addition, a non-spinal nerve block can control pain so you can start a physical therapy or rehabilitation program with more comfort. 
Your doctor may recommend a non-spinal nerve block for the following conditions: 

• Acute pain, including injuries that affect nerves

• Chronic pain, including neuralgias such as long-term pain after shingles (post-herpetic neuralgia) and shooting pain in the lower face and jaw (trigeminal neuralgia) 

• Excessive sweating, also called hyperhidrosis

• Pain syndromes, including phantom limb pain and complex regional pain syndrome

• Pain from blood vessel spasms, including Raynaud’s disease and frostbite

The following specialists commonly perform non-spinal nerve blocks:

• Neurologists specialize in problems of the brain and nervous system, including the spinal cord, nerves, muscles, and related blood vessels.

• Neurosurgeons specialize in the medical and surgical care of people with diseases and conditions of the brain and nervous system.

• Orthopedic surgeons specialize in treating problems of the bones and joints.

• Pain medicine doctors specialize in diagnosing, treating and managing pain and a range of painful disorders.

• Physical medicine and rehabilitation doctors specialize in muscle, bone, and nervous system conditions that affect physical and mental ability.

• Rheumatologists specialize in treating arthritis and other rheumatic diseases that cause inflammation and loss of function of the joints, tendons, ligaments, bones or muscles.

Other specialists who perform non-spinal nerve blocks include:

• Anesthesiologists specialize in preventing and relieving pain.

• Radiologists specialize in imaging and image-guided procedures.

You non-spinal nerve block will be performed in an outpatient setting. It is a minor procedure that involves the following steps:

1. You will lie on a procedure table in a position that allows your doctor to access the injection site.

2. You may have a sedative to help you relax, but will remain awake to tell the doctor about your pain.

3. Your doctor will clean and numb your skin. 

4. Your doctor may use ultrasound or a special X-ray, called fluoroscopy, to guide insertion of a needle to a specific depth. Image-guidance helps your doctor place the needle as close to the nerve as possible.

5. Your doctor will inject medicine once the needle is in place.

6. You will recover for up to 30 minutes and then go home.

7. You will likely return in about a week so your doctor can evaluate your pain.

8. You may need to repeat the procedure in a series of injections for maximum benefit.

Will I feel pain with a non-spinal nerve block?

Your comfort and relaxation is important to both you and your care team. You may feel discomfort, pinching or pressure when your doctor inserts the needle. You may also feel a mild burning when the doctor injects the medicine. Take a few long, deep breaths to help yourself relax. Tell your doctor if any discomfort does not pass quickly. Also tell you doctor if you feel a sudden jolt of pain because this may mean the needle is too close to a major nerve. 

Complications after a non-spinal nerve block are not common, but any medical procedure involves risk and potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery. Risks and potential complications of a non-spinal nerve block include: 

• Allergic reaction 

• Bleeding

• Delivering the medication to the wrong nerve or into the bloodstream

• Difficulty swallowing or speaking, which is usually temporary

• Infection

• Muscle weakness 

• Nerve injury

• Numbness, which is usually temporary

• Spread of the medication to other nerves

Reducing your risk of complications

You can reduce the risk of certain complications by: 

• Following activity, exercise and lifestyle restrictions and recommendations 

• Following instructions after the procedure exactly

• Informing your doctor if you are nursing or if there is any possibility of pregnancy

• Keeping all scheduled appointments

• Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain

• Taking your medications exactly as directed 

• Telling all members of your care team if you have any allergies

You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort and outcome. You can prepare for a non-spinal nerve block by:

• Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.

Questions to ask your doctor

Having a non-spinal nerve block can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before your procedure and between appointments. 

It is also a good idea to bring a list of questions to your appointment. Questions can include:

• Why do I need a non-spinal nerve block? Are there any other options for treating my condition?

• How long will the procedure take? When can I go home?

• What restrictions will I have after the procedure? When can I return to work and other activities?

• How will you treat my pain?

• What kind of assistance will I need at home? Will I need a ride home?

• How should I take my regular medications?

• When should I follow up with you?

• How should I contact you? Ask for numbers to call during and after regular hours.

Knowing what to expect after a non-spinal nerve block can help you get back to your everyday life as soon as possible. 

What can I expect after the treatment?

You will go home soon after your non-spinal nerve block. You should arrange for a ride home because you will have numbness and lingering sedation effects. You will need to rest for the day, so it is also a good idea to have someone stay with you. Most people resume normal activities the following day. 

You will return to your see your doctor in about a week. Your doctor may ask you to keep a pain diary between your procedure and your follow-up appointment. Your doctor will evaluate your pain and decide whether another injection is necessary. 

You may have some soreness around the injection site. Your doctor may have you apply ice or take over-the-counter pain medicines. Tell your doctor if you have more pain, swelling or bruising than expected.

When should I call my doctor?

It is important to keep your follow-up appointments after a non-spinal nerve block. Contact your doctor for questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:

• Bleeding
• Difficulty breathing
• Dizziness or fainting
• Drainage from the injection site
• Fever 
• New or unexplained symptoms
• Pain that is not controlled by your pain medication
• Persistent weakness, heaviness, numbness or tingling 
• Rash or skin irritation
• Redness, warmth or swelling around the injection site

How might a non-spinal nerve block affect my everyday life?

Results of non-spinal nerve blocks vary from person to person. Many people have pain relief that lasts several days to several months. This is often enough relief to help start a physical therapy or rehabilitation program for more lasting relief. However, some people may need a series of injections for maximum relief. If a non-spinal nerve block does not relieve your pain, your doctor will guide you through your other treatment options.