PERIPHERAL NERVE BLOCKS
There are many neuralgias (nerve-generated pains) that are related to specific nerves in the body. Examples would be ilioinguinal neuralgia (leading to groin pain), genitofemoral neuralgia (leading to testicular or vulval pain), lateral cutaneous nerve of thigh neuralgia (leading to thigh pain, and known as 'meralgia parasthetica'), and trigeminal neuralgia, leading to facial pain. There are many others not mentioned here.
Bath Pain Management consultants have many years of experience dealing with these pain conditions, and are able to advise on non-injection and injection-based methods of pain management. Sometimes a peripheral nerve block will be suggested.
A peripheral nerve block is intended to relieve a specific neuralgia (nerve pain) related to that nerve. Although the duration of pain relief is difficult to predict, many patients find that the injections last for some months. If they are effective then they can be repeated. There is always the chance that although the injections are performed correctly, they are ineffective in treating symptoms. Sometimes, the a peripheral nerve block will give good pain relief, but the relief will be short-lived. If this is the case, you may be offered a follow-up treatment, where the nerve is disabled for a longer period of time by the use of radiofrequency microwave heating of the nerve via an injection needle.
We perform many hundreds of injections each year with no complications. However, as with any medical treatment, there are some risks that we will discuss with you. Specifically, we will mention:
a risk that the treatment will not work for you
any injection around a nerve risks nerve damage. The risk is very small (quoted as around 1 in 10,000), and if it occurs, usually temporary. Permanent nerve damage can occur, but it is rare. It is important to understand that often peripheral nerve blocks are performed on nerves that may already be damaged in some way, hence the neuralgia.
if you are a female patient, you may experience abnormal vaginal bleeding following a steroid injection anywhere in the body.
very rarely, steroids used by any route (eg by mouth, inhaled, injected) can cause visual problems. If you have any visual disturbance following a steroid injection, you will need to be seen by an eye specialist to rule out any serious cause.
there may be specific risks with a particular nerve block. Your Bath Pain Management consultant will discuss these with you prior to your treatment.
BEFORE YOUR TREATMENT
Depending on how you are referred to us, we may see you for a consultation beforehand, although on some occasions we will meet you on the day, prior to the injection, to discuss the treatment with you and go through the consent process. Although we can sometimes perform peripheral nerve blocks when you are taking blood thinning medications, it is always important for us to know that you are on these treatments. Please inform your Bath Pain management Consultant when you are discussing your symptoms, or let our administrative staff know prior to your appointment.
ON THE DAY OF YOUR TREATMENT
You will be asked to attend the hospital a little while before your injection so that you can discuss the treatment with your Bath Pain Management consultant. The risks and benefits of the injection will be explained clearly to you.
WHAT HAPPENS DURING THE TREATMENT
There will usually be a nurse present to support you during the injection. The injection is usually performed using an ultrasound machine to identify the nerve, although sometimes xrays or a combination of xrays and ultrasound will be used. Although nerve blocks can be a little uncomfortable when the injection is performed, any discomfort is usually very brief.
WHAT TO EXPECT AFTER THE TREATMENT
After the treatment you will be asked to stay in the hospital a short period of time. This is to ensure that if you have a reaction to the medication, you are a place where we can look after you. After this you will be able to go home. As with many steroid-based injections, it may take up to ten days for the full effects to become evident. We may ask you to fill in a pain diary in the hours and days after the injection to help determine its effectiveness.
FOLLOW UP ARRANGEMENTS
If you are a private patient you will receive a telephone call to check on your progress within three to four weeks. Please note that we are unable to leave answerphone messages for confidentiality reasons, unless your answerphone clearly states that you are the owner and we have your permission. You may be invited back for, or request a follow-up consultation to go through other non-injection treatment options.
We see a small number of patients through the NHS Choose and Book system. Generally follow-up would be provided by your GP, but we are obviously always happy to deal with any concerns you may have after your treatment.