Medial Branch Block: Pre and Post-Procedure Instructions

Pre-Procedure Instructions:

Please carefully review the following instructions:

  1. Infection and Antibiotics: If you are currently taking antibiotics or being treated for an infection, please contact our office before your injection appointment to provide the necessary information.
  2. Procedure Explanation: You have been scheduled for a medial branch block, which is a diagnostic injection to determine if the facet joints along your spine are the source of your pain. The injection will consist of a local anesthetic and is expected to provide temporary pain relief for approximately 4-6 hours. Please note that this procedure is not intended to provide long-term pain relief.
  3. Awake and Alert: Sedation will not be administered for this procedure as you need to be awake and alert immediately afterward to complete a pain diary accurately. You will receive the pain diary form and instructions on the day of your procedure.
  4. Accompanying Driver: While we do not anticipate any weakness or numbness in your extremities, it is advisable to bring a driver with you if possible to ensure your safety and comfort.
  5. Fasting: Refrain from eating or drinking for at least 4 hours before your appointment time. However, you may eat and drink immediately after the injection.
  6. Routine Medications: If you are on routine medications, take them as scheduled on the day of your injection with a small sip of water.
  7. Blood Thinning Medications: If you are taking any blood thinning medications (Plavix®, Coumadin®, Aggrenox®, Lovenox®, Xarelto®, aspirin), please inform our office so that we can provide specific instructions regarding discontinuation.
  8. Generally, we follow the guidelines below:
  • Plavix®: Stop for 7 days before the appointment (cardiologist clearance required if you have cardiac stents).
  • Coumadin®: Stop 5 days before the appointment, with an INR drawn the day before.
  • Lovenox®: Stop 24 hours before the appointment.
  • Xarelto®: Stop 3 days before the appointment.
  • Aggrenox®: Stop 7 days before the appointment.
  • Aspirin: For cervical injections, stop 7 days before; no need to stop before lumbar procedures.
  • Anti-inflammatory medications (Motrin®, ibuprofen, Advil®, Aleve®, etc.): For cervical injections, stop 5 days before; no need to stop for lumbar procedures.

Post-Procedure Instructions:

Please carefully review the following instructions:

  1. Numbness and Pain Diary: Following the medial branch block procedure, the injected facet joints may remain numb for the next 4-6 hours. During this time, engage in activities that typically cause your usual pain symptoms. Keep track of your pain relief by completing the 24-hour pain diary provided to you.
  2. Pain Diary Submission: Fax your completed pain diary to (415) 492-1688 or drop it off at our office at your convenience. Kevin Holman, PA-C, will contact you in the next few days to discuss the results of the test.
  3. Repeat Procedure and Radiofrequency Ablation: Depending on your specific situation, your medial branch block may need to be repeated twice to confirm the results. If your typical pain is reduced by more than 50%, you may be a candidate for radiofrequency ablation. This procedure involves heating the medial branch nerves that supply the facet joints, potentially providing long-term pain relief lasting 6 months to 2 years.
  4. Return of Regular Pain: It is important to remember that the medial branch block is only a diagnostic test, and your regular pain typically returns within 24 hours.
  5. Complications and Contact: While complications from this procedure are extremely rare, if you experience excessive pain, redness at the needle sites, or any signs of infection, please contact our office immediately.

Please follow these instructions carefully and feel free to reach out to our office if you have any questions or concerns.