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Precision nerve block

Pain relief procedures that act directly on the nerve, thus eliminating pain even right away, will soon be available in our outpatient Pain Management Clinic. One such procedure is the precision nerve block injection.

There are two important points that make the invasive interventions available in our polyclinic different from those available elsewhere:

– at our polyclinic, these invasive procedures are performed by neurosurgeons,

– nerve block injections are administered under X-ray image intensification control, giving the surgeon a real-time view of the injection area, which enables highly precise targeting and safe performance of the procedure, as well as effective treatment.

Our neurosurgeons are Dr Máté Nagy, profile leader, Dr Adrien Rácz and Dr.Levente IIyés.

One such procedure is the precision nerve block injection.

About the nerve block injection

A nerve block injection is an effective pain relief intervention, during which a special medication is injected by a neurosurgeon or pain therapist into the nerve or nerve root supplying a particular joint. The aim of the injection is to temporarily or for longer term block the nerves that transmit pain, that is, to reduce or eliminate the transmission of impulses of the given nerve and thereby pain and inflammation.

A specialist neurosurgeon/pain therapist uses medication (in most cases an injection containing steroids and lidocaine or its derivatives) to block the sensation of pain in the affected nerve. In many cases, the feeling of pain as a symptom disappears immediately after the injection and, depending on the administered drug component and the target, pain-free or reduced pain period can be achieved for even several months.

Nerve block injection helps to relieve/eliminate pain

A procedure to relieve pain in various parts of the body can help reduce pain in the lower back, legs and feet caused by sciatica, hernia or other problems with nerves along the spine. At our polyclinic, we can perform our procedures in a priority treatment room under appropriately sterile conditions. Injections are administered under X-ray image intensification control, giving the surgeon a real-time view of the injection area, which enables highly precise targeting and safe performance of the procedure, as well as effective treatment. The intervention itself is carried out with as little pain as possible under local anaesthesia.

Below, there are some examples of the most commonly treated areas:

  1. Spinal pain: this includes neck, back and lower back pain. Injections are usually given in the vicinity of the nerves that innervate the small joints adjacent to the spine (medial branch), and in the lumbar region (lower back), next to the former target, in the sacroiliac joint which is located between the sacral spine and the pelvis, to reduce inflammation and pain. In addition to the two most frequently affected areas mentioned above, the target may be the spinous process of the vertebrae, or the muscles adjacent to the spine, or the attachment point of certain ligaments.
  2. Sciatica, that is the pain of the sciatic nerve (ischiadic nerve): the sciatic nerve is actually made up of several nerve roots (L4-S3) and when irritated, nerve pain can be felt in the side and back parts of the lower limb, in the entire area of the leg (colloquially: the foot), and sometimes there can be a weakening of certain muscle groups in these areas. Nerve root irritation can have several causes, depending on the cause, a nerve root blockade administered next to the spine can eliminate or reduce the pain.
  3. Piriformis syndrome: causes pain in the back of the leg, similar to sciatica, symptoms usually worsen with prolonged sitting. It is caused by abnormal tightening of the piriformis muscle deep in the buttock area, thereby pinching the sciatic nerve (nervus ischiadicus). The injection is given into the piriformis muscle in the buttocks and the pinching of the nerve and the pain are eliminated by relaxing the muscle.
  4. Hip and knee pain: if the hip pain is caused by lumbar nerve root entrapment, nerve root blockade can be used to eliminate/reduce it.

The procedure can be used to relieve nerve pain, such as pain caused by nerve root compression (radiculopathy) due to spinal disc herniation or pain caused by nerve damage (neuropathy).

The effect of the injection is usually felt immediately because, unlike the treatment available in most places, the medication is delivered directly to the affected nerve or nerve root. The anaesthetic effect can last up to several months, depending on the type of medicine used, and may also depend on individual reactions. The duration of the effect of the blockade can therefore vary.

Which doctor performs the nerve root block injection?

Nerve root blockade is performed in our practice by an exceptionally trained neurosurgeon/pain therapist or anaesthesiologist. They have the appropriate anatomical knowledge and experience to carry out this precision procedure.

What device does the doctor use to perform the injection blockade?

Using a device, the so-called fluoroscopic image intensifier (a smaller X-ray), the doctor gets a real-time image of the injection area, allowing more precise targeting and the safe performance of the procedure.

This device helps the doctor to accurately guide the needle and injection to the given joint or nerve root, minimising the risk of damage to the surrounding tissues and nerves and ensuring that the active ingredients are delivered precisely to the target.

A sterile environment and appropriate equipment are available in our polyclinic to perform nerve block injections.

The steps of the nerve block injection’s procedure – as a minimally invasive intervention: 

  1. Preparations: the patient is comfortably positioned on the operating table in sterile conditions.
  2. Local anaesthesia: a local anaesthetic is applied at the injection site to minimise the discomfort caused by the precision injection.
  3. Intervention management: the doctor uses a fluoroscopic (X-ray) imaging device to properly visualise the given anatomical position and the injection site. This helps the doctor to target the injection accurately.
  4. Injection: the doctor inserts a thin needle through the skin to the given joint or nerve that innervates it, or in close proximity to the nerve root. The needle is used to deliver the medication (usually a combination of local anaesthetic and possibly anti-inflammatory agents) to the right place. The procedure usually takes 20 minutes.
  5. Follow-up and aftercare: the doctor will monitor the patient after the procedure. After the injection, the affected limb may feel warm, numb or even weak, which is due to the local anaesthetic used and it is a natural phenomenon. It may last up to a day, but usually only a few hours. Observation is usually required for up to an hour after the procedure. It is recommended to have a rest and relax the spine for 24 hours after the procedure. The patient can continue his/her normal diet and medication immediately after the procedure, but driving and vigorous physical activities are not recommended on the day of the intervention.

You are advised to leave the polyclinic with the help of an escort after the procedure.

About the nerve roots and nerves near the spine

Between the vertebrae that make up the spine, a pair of nerves emerge from the spinal canal on both sides. In the case of the cervical vertebrae, they run towards the upper limbs, and in the case of the lumbar vertebrae, they run to the lower limbs. Irritation of these nerves, such as herniated discs or piriformis syndrome, can lead to nerve inflammation (radiculopathy) and can be accompanied by a feeling of pain radiating to the given limb.

The background of lumbago, i.e. acute lower back pain, is the acute inflammation of the small joints around the spine at the level of the waist, acute inflammation of the sacroiliac joint, abnormal contraction of the muscles around the lower back and consequent irritation of the ligaments and periosteum. Isolated lumbago is rarely caused by spinal hernia, but sciatica and lumbago often occur together

How do we treat conditions?

In most cases, conditions can be treated with medication, physical therapy and physiotherapy (overall, in a conservative way). However, if the pain does not go away, or does not disappear sufficiently, it is worth localising the source of the pain and intervening with a single, so-called minimally invasive treatment. Such an invasive intervention is the aforementioned nerve or nerve root blockade.

Effects of the intervention

Sudden pain relief – or even disappearance of the pain – is provided by the lidocaine component of the drug combination administered, while longer-term pain relief is provided by the steroid effect that builds up by the fourth day after the procedure. In some cases even the nerve conduction recalibration (releasing) effect of lidocaine on the nerve can cause long-term pain relief. How long the pain relief lasts will vary for each patient, it can last for several months. Repeated injections from time to time can maintain the desired condition in the long term.

When can the intervention not be carried out?

Nerve block injections cannot be used in all cases. There may be contra-indications if someone is allergic to the medicine used, has a serious infection, has a blood clotting disorder, or is taking a medicine that affects blood clotting. In addition, prior consultation with a doctor is necessary if someone is pregnant or has certain chronic diseases. Special care is needed if the patient is being treated for high blood pressure or diabetes.

It is important to note that before the procedure, the doctor will perform a detailed medical examination and decide whether to apply the blockade depending on the cause of the pain. The efficacy and applicability of the intervention may vary from individual to individual, so it is important to consult the doctor to choose the most appropriate treatment option.

The expert for this article is Dr Adrien Rácz, neurosurgeon.

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