Important information to patients

Before any interventional procedure, you will need to keep nil by mouth for 6 hours.

It is important to inform us as soon as possible on 01245234128, if you have any allergies or if you are on specific blood thinning tablets or injections.

After the procedure, you must always have someone to accompany you from hospital and to take care of you for 1st 24 hours.

You will be offered intravenous sedation during the procedure for you to feel comfortable; you will be awake & should be able to communicate throughout the procedure. Your skin and deeper tissues will be numbed with a local anaesthetic at the site of injection.

The procedures are done under X-ray control in order to increase their accuracy and a radio-opaque dye is routinely injected to confirm the needle position.

Your position on the operating table depends on the site of the procedure.

You are strictly advised not to drive after the procedure and will need to rest. Please make necessary arrangement in advance.

Epidural injections

Epidural injections are carried out by introducing local anaesthetic and anti-inflammatory steroid medications onto the surface of the epidural space and around the nerve roots.

This procedure is valuable for the diagnostic information about the source of the pain and may reduce the inflammation. Reduction of inflammation may help the natural healing resulting in long-term pain relief.

It is also important to note that an epidural injection itself is not the cure for your pain but it will give you pain relief and enable you to progress with exercise/rehabilitation improve back health.

With the injection of medication, you may feel brief pressure like sensation in various part of the body depending on the site.

Possible complications include low blood pressure (treated by intravenous fluid if necessary) infection and inability to pass urine for a few hours (treated by inserting a catheter). Your legs (caudal or lumbar epidural) or arms (cervical epidural) may be numb and heavy for a few hours - this is normal and harmless!

Epidurogram

This procedure is done to determine the extent of scar formation, which can cause trapping /irritating nerves in your back giving pain. Scarring is most commonly caused from subsequent healing process following back surgery or following disc ruptures and its contents leak.

Following injection of radio opaque contrast to the epidural space, if scar tissue seems to be the problem, you may later be admitted for the percutaneous epiduroplasty.

After the epidurogram routine epidural will be performed with local anaesthetic & steroid to help your pain.

Possible complications include low blood pressure (treated by intravenous fluid if necessary) infection and inability to pass urine for a few hours (treated by inserting a catheter).

Your legs (caudal or lumbar epidural) or arms (cervical epidural) may be numb and heavy for a few hours - this is normal and harmless!

Percutaneous epidural adhesiolysis (Epiduroplasty)

Percutaneous epidural adhesiolysis is a technique used to treat patients with refractory low back pain due to epidural scarring or spinal stenosis. Scarring is most commonly resulted from subsequent healing process following back surgery or following disc ruptures and its contents leak.

The purpose of percutaneous epidural adhesiolysis of adhesions is to eliminate the deleterious effects of scar formation, which can physically prevent direct application of medications to nerves or other tissues.

Insertion of the catheter through a needle in to the deeper tissues may cause some discomfort. Applying a small amount of current will cause a tingling or pain sensation running down the same area as your normal pain. It is very important that you to tell the doctor as soon as you start feeling this sensation. This is done to identify the exact source of pain.

Catheter will be fixed to the skin which will be used to give mixture of saline, local anaesthetics, drugs, steroids and x-ray contrast dye to visualise the scarred space. Immediately after the injection, your legs may feel slightly sore, heavy or numb. You may also, notice that the pain quickly improves. This is due to the local anaesthetic injected and will last only for a few hours. After the initial injection same injections will be repeated in regular intervals while you will be asked to carry out some stretching exercises. The catheter will be removed after 8 to 10 hours from the start of the procedure.

You will be given an intravenous antibiotic before the procedure starts and you will also be asked to take oral antibiotics for five days after the procedure to prevent any infections. You should be able to return to work the day after the procedure. The most common thing you may feel is a sore back.

There may be a temporary increase in your pain symptoms due to the volume of the injection in your epidural space. There is a very small possibility of headache due to accidental puncture of the dural membrane, but this headache is temporary and responds well to lying down, simple painkillers and drinking plenty of liquids. There is a very small risk of damage to the nerve but very unlikely as you will be awake and you will feel severe pain if the needle touches the nerve.

Diagnostic Injections

Facet joints
Sacro-iliac joints
Hip joints
Nerve roots
Peripheral nerves

These injections are performed to diagnose the possible source of pain. This will decide after your consultation, clinical examination and findings. If the clinical findings shows symptoms of pain arising from facet joints (tiny joints in your spine), sacroiliac joints (major joins in the pelvis), Hip joints, or nerves roots.

Joint or nerve roots will be numb with only very small amount of local anaesthetic solution. During the procedure you may feel very slight pain, discomfort or pressure.

After the injections you will be examined again to find out the, effectiveness of the injections and discuss the next phase of the treatment which will be according to your initial pain & findings.

If the test injection relives your pain it will be only for few hours, and pain will return therefore you need to continue your usual pain medications.

Possible complications include numbness or heavy legs/hands which are harmless & return back to normal in few hours, infections needing antibiotic treatment.

Therapeutic joint injections

Facet joints
Sacro-iliac joints
Hip joints

Mixture of steroids & local anaesthetics injections will be used to perform therapeutic injections. Aim is to reduce the inflammation & pain that may be present in small or large joints.

You will be examine under the fluoroscopic guidance to confirm the possible source of pain & to enhance the accuracy of needle position.

During the procedure you may feel very slight pain, discomfort or pressure.

Effectiveness of facet joint injections may vary from minimal to long term, or some cases may not produce any relief.

Possible complications include numbness or heavy legs/hands which are harmless & return back to normal in few hours, infections needing antibiotic treatment or flair up of pain for few days.

Pulsed Radio frequency

Dorsal Root Ganglion
Peripheral Nerves

Pulsed radio frequency is a technique which a radio frequency electrical field is applied intermittently to the nerve which may be responsible for transmitting pain signals to the brain. Current is applied through a fine needle in short intervals to keep the temperature below 42°C. Even though how it works is not fully understood, it known to give long-term pain relief.

This procedure is used following the diagnosis (clinical or diagnostic blocks) of particular nerve, nerve root, nerve ganglion, as the cause of you pain.

An electrode (a fine needle) is inserted very close to the nerve which may be involved in pain transmission. The correct nerve is then located by gentle stimulation and you will feel a tingling sensation running down the same area as your normal pain. At the time of the procedure you may feel strong pulse in the area being treated. Immediately after the treatment the majority of patients feel an improvement or relief in their pain, but in some patients the relief may take a few weeks to take effect.

Possible complications include numbness or heavy legs/hands which are harmless & return back to normal in few hours, infections needing antibiotic treatment or flair up of pain for few days.

Radiofrequency Denervation

Facet joints
Sympathetic ganglion (nerve complexus)

This is therapeutic procedure where radiofrequency current is used to generate heat on specifically identified nerves. By generating heat it destroys the tissue in the immediate vicinity including the nerve (generally sensory nerves). This will stop the nerve ability to transmit pain signals to the brain, thus ablating the nerve. Radiofrequency ablation will strictly performed after only diagnostic facets or nerve blocks to confirm the origin of the pain.

An electrode (a fine needle) is inserted very close to the nerve which may be involved in pain transmission. The correct nerve is then located by gentle stimulation that you feel a tingling, pressure, heaviness, warm or pulsing sensation. I will also numb the nerve before ablation so that you will feel minimal discomfort. It could take up to 1-2weeks or longer to feel pain relief, however there could be some poor outcomes. Following a successful Radiofrequency denervation pain relief can last longer than any other local anaesthetic or steroid bocks, but pain may return due to regeneration of sensory nerves.

Possible complications include numbness or heavy legs/hands which are harmless & return back to normal in few hours, infections needing antibiotic treatment, or flair up of pain for few days.

Sympathetic Nerve Blocks

A sympathetic nerve block can be used to diagnose or treat pain involving the nerves of the sympathetic nervous system.

Sphenopalatine ganglion block
Stellate ganglion block
Thoracic sympathetic block
Splanchnic pleus block
Coeliac plexus block
Lumbar sympathetic block
Superior hypogastric block
Pelvic sympathetic (Ganglion Impar) block

Sphenopalatine ganglion block

This procedure is done for facial pain & headaches. Procedure target deep nerve complexes in the head.

You will be asked to lie on your back with head placed on a special head rest. Following careful needle position medications will be injected or in the event of pulsed radiofrequency or radio frequency procedures, test current will be passed.

Possible complications include infection local bleeding and flare up of the pain.

Stellate ganglion block

A Stellate Ganglion Block is an injection of local anaesthetic around the bundle of sympathetic nerves in the neck. The nerves are located on either side of the voice box, at the base of the neck. This block, may help to reduce pain, swelling, discolouration and sweating changes in the arm and may improve its function. This procedure may carry out as a part of the multidisciplinary pain management.

You will be asked to lie on your back with head placed on a special head rest. Following careful insertion, position of the needle will be confirmed by radio-opaque dye or in the event of pulsed radiofrequency or radio frequency procedures test current will be passed.

Immediately after the injection, you may feel, red/pink face with drooping eyelid, sunken eye lid, a lump in the throat feeling, hoarsening of the voice, one sided nasal stuffiness, a warm pink arm / hand / face, rise in skin temperature of the affected arm (at least 2 deg C) and reduction of pain. Except pain all the other symptoms will disappear in a few hours.

Possible complications include infection and local bleeding; it is rare to have pneumothorax or cardiac arrhythmias.

Thoracic sympathetic blocks

The thoracic sympathetic block is an injection of local anaesthetic around the bundle of sympathetic nerves in the back of the chest. This block may help to reduce pain in, the chest wall, the upper extremity, hand & the neck. This procedure may be carried out as a part of the multidisciplinary pain management.

You will be asked to lie on your front with head placed on a special head rest.

Following careful insertion, accurate position of the needle will be confirmed by radio-opaque dye or in the event of pulsed radiofrequency or radio frequency procedures test current will be passed.

Immediately after the injection you will feel the hand getting warm and relief of pain. Except pain relief all the other symptoms will disappear in a few hours.

There is a possibility of dropping blood pressure following the procedure. You may need a normal saline drip to counteract the possible drop in blood pressure

Possible complications include pneumothorax infection and local bleeding. We will monitor you for 2 – 4 hours after the procedure and we may perform repeat chest x-ray to exclude any pneumothorax before you are discharged.

Coeliac plexus block

Coeliac plexus block is an injection of local anaesthetic solution around a bundle of sympathetic nerves which has communication with abdominal organs. The coeliac plexus is located close to the spine on either site, at the level of your umbilicus. This block may help to reduce pain arising from abdominal organs. You will be asked to lie on your front with head placed on a special head rest, we may also asked to keep a pillow under the abdomen to improve the position.

Following careful insertion, accurate position of the needle will be confirmed by radio-opaque dye or in the event of pulsed radiofrequency or radio frequency procedures test current will be passed.

Immediately after the procedure you will also feel heaviness with redness of your legs. Except pain relief all the other symptoms will disappear in a few hours. You may need a normal saline drip to counteract the possible drop in blood pressure You may also need leg stocking to prevent blood pressure drop. Possible complications include infection and local bleeding.

Lumbar sympathetic block

A lumbar sympathetic block is an injection of local anaesthetic solution around a junction or ‘crossroads’ where many sympathetic nerves meet. This nerve resides either side of the spine in the back. This crossroads can sometimes be responsible for sending pain messages to the brain, from the leg, and occasionally the lower back. This block may also perform as a part of the multidisciplinary pain management for complex regional pain syndrome in leg.

You will be asked to lie on your front with head placed on a special head rest and a pillow under the pelvis to improve the position.

Following careful insertion, accurate position of the needle will be confirmed by radio-opaque dye or in the event of pulsed radiofrequency or radio frequency procedures test current will be passed.

Immediately after the procedure you will feel heaviness with warm pink leg. Except pain relief all the other symptoms will disappear in a few hours. You may need a normal saline drip to counteract the possible drop in blood pressure.

Possible complications include infection and local bleeding.

Superior hypogastric block

Superior hypogastric block is an injection of local anaesthetic solution around a bundle of sympathetic nerves which has communication with pelvic organs. This nerve bundle resides very close to either side of the spine in the lower part of the abdomen. This block may help to reduce the pain arising from the pelvic organs.

You will be asked to lie on your front with head placed on a special head rest and a pillow under the pelvis to improve the position.

Following careful insertion, accurate position of the needle will be confirmed by radio-opaque dye or in the event of pulsed radiofrequency or radio frequency procedures test current will be passed.

Possible complications include infection and local bleeding.

Pelvic sympathetic (Ganglion Impar) block

Ganglion impar block is an injection of local anaesthetic solution around a bundle of sympathetic nerves which communicates with perineum. This nerve bundle resides in front of the coccyx. This block may help to reduce the pain arising from the perineum as well as coccyx.

You will be asked to lie on your front with head placed on a special head rest.

Following careful insertion, accurate position of the needle will be confirmed by radio-opaque dye.

Possible complications include infection and local bleeding.