Overview

These injections are given around a peripheral nerve in the body, to give pain relief, and sometimes to help with diagnosis. The injections contain local anaesthetic, often with a small amount of steroids. The injection is usually given alongside other treatments, such as physiotherapy.

Side effects

As with any procedure, you can have side effects. However, these are usually minor and there is little risk of serious harm.

Common side effects

• Mild tenderness or bruising at the injection site, that usually settles over the first few days.
• A metallic taste.

Rare side effects

• The local anaesthetic might spread, causing some numbness or weakness in your legs (or other areas depending on the location of the block). If this happens, the effect is temporary and will quickly get better over minutes or, rarely, hours.
• Infection that might require antibiotic treatment. Seek medical help if there is warmth, redness or soreness at the injection site, or you feel hot and unwell.
• Nerve injury. This is extremely rare (less than 1 in 10,000 patients).
• During the injection, you might get signs of local anaesthetic toxicity if the injection is passing into a blood vessel.

Other treatment options

Any other treatment options will be discussed with you before you make a decision to have the injections. The decision about treatment is shared between you and your doctor. Your doctor can give you information about the chances of this being a successful treatment for you, and how it fits into your care pathway.

If you are undecided about treatment, more advice and information can be provided. Please speak to your doctor about this.

There is a chance that the treatment might not help your pain.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we will ask you to sign a consent form. This says that you understand what is involved and agree to have the treatment.

Read more about our consent process.

Before treatment

It is important to let your doctor know if:

• your health has changed
• you have an infection in your body or on the skin of your back (your doctor will delay the treatment until the infection has gone)
• you use anticoagulant or antiplatelet medicines (medicines that thin your blood) such as warfarin, heparin or clopidogrel (you might need extra preparation)
• you have diabetes (some steroids might cause your blood sugar to change, needing monitoring and adjustment of your diabetic medicines)
• you have any allergies

You must also tell the doctor if there is any chance that you could be pregnant.

If you are planning to travel abroad or fly within 2 weeks after the injections, let your doctor know as it might be best to change the date of the injections.

Always bring a list of all your current medicines.

Continue to take your medicines as usual on the treatment day (unless you are taking medicines that thin your blood, such as warfarin, rivaroxaban, heparin, or clopidogrel). If you take these, or are unsure if you do, please contact us at least 2 weeks before your procedure to help us manage these.

During treatment

Not all doctors give these injections in exactly the same way, but this is generally what will happen.

• Observations, such as blood pressure and pulse rate might be taken.
• A small needle (cannula) might be placed in the back of your hand.
• You will be carefully positioned, and the skin around the injection sites will be cleaned with an antiseptic solution or spray. This can feel very cold.
• Sometimes electrical stimulation of the nerve, X-ray machines (or other forms of image guidance) are used to allow us to give the injection accurately.
• You will feel a stinging sensation as local anaesthetic is injected to numb the skin and surrounding tissues. Your doctor will tell you before they do this.
• The doctor will direct the needles to the nerves carrying sensation from the areas suspected to be the source of your pain.
• When the injections are given, you might feel pressure, tightness or a pushing sensation. If there is any discomfort, let the doctor know.

After treatment

After the injections, you will be taken to a recovery ward where nursing staff will monitor you. You will be told when you can get dressed, and be given help to make sure that you can stand safely after the procedure.

Your pain will be assessed at rest and during daily activities, to find out how much pain relief you have immediately after the injection. This might help plan future treatments. You will be given more advice when you are ready to leave.

Leaving hospital

You can usually leave hospital within a few hours after the injections, and sometimes sooner. This will depend on how many injections are given and how long we want you to stay for to recover.

Before you go home you will be given information about who to contact if the pain management department is closed.

Please make sure that you have arranged for someone to collect you after the procedure. If this is not done, your procedure will probably have to be cancelled.

It is unsafe for you to drive immediately after the procedure. If you do, your motor insurance will not be valid.

Ideally, you should arrange for someone to stay with you for 24 after your treatment. If this is not possible, you should at least have access to a phone.

For the first 24 hours after your injections:

If you are unsure, please talk to your doctor for advice.

You might have some soreness or aching at the injection site.

If you have any sterile dressings, you can remove them before going to bed.

Please keep the injection sites dry for 24 hours after the procedure.

Do not worry if your pain feels worse for a few days as this sometimes happens. Take your regular pain killers and medicines and this should settle down. Try to keep moving about the house, but avoid anything too strenuous.

As your pain decreases, you should try to gently increase your exercise. Simple activities like a daily walk, using an exercise bike, or swimming on your back, will help to improve your muscle tone, and strengthen your back. It is best to increase your activities slowly. Try not to do too much on a good day, as it can cause you more pain the next day.

When to get help

Returning to work

This will be different for everyone, and might depend on the type of work you do, so you should discuss this with your doctor.

Follow-up appointments

You will receive details of a follow-up appointment. It will be a phone call or at the hospital, with a nurse specialist or consultant. If you haven’t heard from us within 10 weeks after the procedure, please contact us, phone 020 7188 8877, Monday to Friday, 9am to 5pm.