Facet Block

A facet block is an injection procedure used to numb nerves near a spinal joint (facet). The injection usually includes a medicine like Novacaine (anesthetic) and a steroid medicine (similar to cortisone). The injections are made directly into the facet joint of the back. They are used for patients with several types of neck or back pain problems (such as worsening arthritis or persistent pain after surgery) that have not been helped with anti-inflammatory medications, exercise programs, physical therapy, and other forms of pain management. Multiple injections may be needed depending on how many joints are involved.

A facet block procedure can be helpful with diagnosis as well as providing therapeutic pain relief. One of three things may happen after the procedure:

  • The pain does not go away. This can mean that the pain is probably not coming from blocked facet joints. This information is helpful with diagnosis.

  • The pain goes away and stays away for a few hours but the original pain comes back and does not get better again. This information is also helpful with diagnosis. It can mean that pain is probably coming from the joints; but the steroid was not helpful for longer term pain control.

  • The pain goes away after the block, then returns later that day, and then gets better again over the next few days. This can mean that the block was helpful for pain control and the steroid had a longer lasting effect.

If there is good, lasting benefit from the injections, the block may be repeated from 3 to 5 times. If there is good relief but it is only of short-term benefit, other procedures (such as radiofrequency lesioning) may be considered.

Note: The procedure cannot be performed if you have an active infection, a lesion on or near the area of injection, 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!

LET YOUR CAREGIVER KNOW ABOUT:

  • Allergies.

  • Medications taken including herbs, eye drops, over the counter medications, and creams

  • Use of steroids (by mouth or creams).

  • Possible pregnancy, if applicable.

  • Previous problems with anesthetics or Novocaine.

  • History of blood clots.

  • History of bleeding or blood problems.

  • Previous surgery, particularly of the neck and/or back

  • Other health problems.

RISKS AND COMPLICATIONS

These are very uncommon but include:

  • Bleeding.

  • Injury to a nerve near the injection site.

  • Weakness or numbness in areas controlled by nerves near the injection site.

  • Infection.

  • Pain at the site of the injection.

  • Temporary fluid retention in those who are prone to this problem.

  • Allergic reaction to anesthetics or medicines used during the procedure.

Diabetics may have a temporary increase in their blood sugar after any surgical procedure, especially if steroids are used. Stinging/burning of the numbing medicine is the most uncomfortable part of the procedure; however every person's response to any procedure is individual.

BEFORE THE PROCEDURE

  • Your caregiver will provide instructions about stopping any medication before the procedure.

  • Unless advised otherwise, if the injections are in your neck, you may take your medications as usual with a sip of water but do not eat or drink for 6 hours before the procedure.

  • Unless advised otherwise, you may eat, drink and take your medications as usual on the day of the procedure (both before and after) if the injections are to be in your lower back.

  • There is no other specific preparation necessary unless advised otherwise.

PROCEDURE

After checking your blood pressure, the procedure will be done in the x-ray (fluoroscopy) room while lying on your stomach. For procedures in the neck, an intravenous line is usually started. The back is then cleansed with an antiseptic soap. Sterile drapes are placed in this area. The skin is numbed with a local anesthetic. This is felt as a stinging or burning sensation. Using x-ray guidance, needles are then advanced to the appropriate locations. Once the needles are in the proper location, the anesthetic and steroid is injected through the needles and the needles are removed. The skin is then cleansed and bandages are applied. Blood pressure will be checked again, and you will be discharged to leave with your ride after your caregiver says it is okay to go.

AFTER THE PROCEDURE

You may not drive for the remainder of the day after your procedure. An adult must be present to drive you home or to go with you in a taxi or on public transportation. The procedure will be canceled if you do not have a responsible adult with you! This is for your safety.

HOME CARE INSTRUCTIONS

  • The bandages noted above can be removed on the morning after the procedure.

  • Resume medications according to your caregiver's instructions.

  • No heat is to be used near or over the injected area(s) for the remainder of the day.

  • No tub bath or soaking in water (such as a pool, jacuzzi, etc.) for the remainder of the day.

  • Some local tenderness may be experienced for a couple of days after the injection. Using an ice pack three or four times a day will help this.

  • Keep track of the amount of pain relief as well as how long the pain relief lasted.

SEEK MEDICAL CARE IF:

  • There is drainage from the injection site.

  • Pain is not controlled with medications prescribed.

  • There is significant bleeding or swelling.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You develop a fever of 101° F (38.3° C) or greater.

  • Worsening pain, swelling, and/or red streaking develops in the skin around the injection site.

  • Severe pain develops and cannot be controlled with medications prescribed.

  • You develop any headache, stiff neck, nausea, vomiting, or your eyes become very sensitive to light.

  • Weakness or paralysis develops in arms or legs not present before the procedure.

  • You develop difficulty urinating or difficulty breathing.