Selective Nerve Root Block

Treatment Information

What is a selective nerve root block?

If your pain is thought to be primarily through one nerve root distribution, and you have not responded to the epidural injection, you may be a candidate for the selective nerve root block. This is the injection of local anesthetic and steroid medication at the specific nerve root in question. If your pain improves even while the local anesthetic is effective, then the selective nerve root block is considered a positive block. This block can be diagnostic to diagnose the cause of your pain, and it can be therapeutic by improving the pain.


What are reasons NOT to do a selective nerve root block?

A selective nerve root block will NOT be performed if you have an active infection, fever, bleeding problems, allergy to the local anesthetic and steroid, and/or pregnancy.


What are the preparations for the procedure?

Before the procedure, you are asked NOT to eat for four (4) hours prior and NOT to drink liquids two (2) hours prior to your procedure, as you will not be permitted to drive a vehicle on the day of your procedure. Anyone who is taking a blood thinning medication such as coumadin will be required to stop that medication for a specified time period before the procedure. Otherwise, you make take your regularly prescribed medications the morning of your procedure with a sip of water. If you are a diabetic patient, you may eat a limited amount before your procedure to avoid hypoglycemia.


What are possible complications from the procedure?

Complications that can occur include but are not limited to dural puncture, spinal cord trauma, infection, hematoma formation, epidural lipmatosis, pneumothorax, nerve damage, headache, intravascular injection, vascular injury and reaction to local anesthetic and steroid.


What are possible side effects of the steroid medication?

Administration of steroid medication can cause side effects. Side effects can include but are not limited to hyperglycemia, altered menstrual cycle, fluid retention, bruising, insomnia, sweats, hot/cold flashes, flushing of the face, weight gain, epidural lipomatosis, steroid myopathy, avascular necrosis of bone, osteoporosis and Cushing's syndrome.


What will occur during the selective nerve root block?

After the procedure and complications have been explained by the physician or physician assistant, an informed consent paper, (giving permission for the procedure), must be signed by the patient. Then, the patient is taken to the procedure room by a staff member. You will then lie down on the x-ray table on your stomach. The area to be injected will be cleaned using an antiseptic solution, which is usually betadine unless you are allergic to this. Numbing medicine will then be injected under the skin to numb the area where the injection will occur. The physician will then guide a needle into the appropriate area under x-ray. Then the medicine will be injected Remember, the needle may not be necessarily be placed in exactly the same area as your pain. When the medicine is injected you may feel pressure sensation in your back and/or arms or legs that may be similar to your original pain.


How long is the procedure?

Usually this procedure takes approximately 15 minutes to complete.


What happens after the procedure?

After the procedure is completed, the patient is take to our recovery area. There, you will be monitored closely by checking the blood pressure, heart rate, and pain score level. You may be giving something to drink at this time. Also, the staff will be observing for any signs of side effects from the procedure. When ready, you will be given discharge instructions and any follow-up information that is needed. Remember, you may experience numbness in the affected area until the local anesthetic wears off completely.


Important Notes

  • If you suspect that you are might be pregnant or know you are pregnant, please notify the physician or any staff member, as this is a reason NOT to do the selective nerve root block.
  • If you are a diabetic patient taking insulin or pills to manage your diabetes, the steroid used in this injection can raise your blood sugar level temporarily. You should monitor your blood sugar level closely after your procedure. If your blood sugar level continues to be elevated then contact your primary care physician for suggestions on how to best manage this issue.

* If you do not understand any part of the above material, please discuss it with your physician or physician assistant. *


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