Overview: These techniques involve injecting combination of local anaesthetic and steroid. These medicines cause numbing of the area of pathology thus reduces pain with variable results.
Injection techniques have been practiced as a pain management option since many years with variable results. A patient suffering from inflammatory pathology of spine can expect to get relief from injections. These injections contain a combination of local anaesthetic and steroid. These act by temporarily by numbing the area of pathology. These are particularly indicated in patients suffering from pain not get relieved by oral medications and conservative treatment.
Similarly they are neither candidates for surgery presently (since the surgeon feels that the pathology does not warrant surgery or the patient is not willing and wants to try other modalities of pain relief). In this process, these injections can also help the surgeon diagnose the pathology in doubtful cases. This is because the surgeon/ pain specialist injects a particular nerve. If the patient gets better, it gives an indirect evidence that the injected nerve is the culprit. Patients with neurological deficit (weakness in arms/ legs), uncontrolled diabetes, on blood thinners, known allergies and active local or systemic infection are few contra indications of the procedure. The benefits of the procedure are that it causes minimum harm to the body and delivers the drug at the site of pathology, unlike oral medications which may damage various organs during the process. They may also break the pain cycle so that patients can be put on physiotherapy and rehabilitation program which may treat the cause of pain. Similarly, it helps patients to buy time for definitive treatment like surgery. These are especially useful in older people where very few options of treatment are available. The effect of this procedure may last for a few days to few months. Sometimes, they may not produce any beneficial effects. Usually, maximum, 2-3 injections are recommended in a year. These procedures don’t have high complication rates. Occasional, the medication may spread to nearby neuro- vascular structures. In such cases, they may have serious consequences. These injections are given as a day care procedure. Patients are advised few preliminary blood tests and investigations. If on blood thinners, they are advised to be stopped 2-5 days before the procedure. Fasting for a few hours before the procedure is recommended. This procedure is done in an operating room under sterile conditions and C-arm guidance (Intra operative X-ray). Patient is positioned prone (head down) on operating table. Local anaesthesia and sedation is given. Under C-arm guidance the needle is inserted at the level of pathology. A dye may be injected to delineate the nerve. After confirmation, the combination of local anaesthetic and steroid in injected. There are various types of injection techniques which target different parts of spine like facet joint blocks, SI joint blocks, caudal epidurals, transforaminal nerve blocks, etc. Patient is then shifted in observation room for few hours. If medically and neurologically stable, discharge is planned. A short course of oral analgesics and antibiotics may be given and follow up is advised after a few days.
Disclaimer: The description of procedure is how usually a surgery is done. During the procedure, based on intra operative encounters which varies from patient to patient different steps may be performed.
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