Cervical Nerve Block

What is a Cervical Nerve Block?

The Cervical Nerve Block
is different from the Lumbar Block in that it is performed at the front of the body, near the neck, instead of the lower back. It is usually performed when the patient is suffering from shoulder, arm, hand, and/or neck pain. whereas the lumbar blocks are typically done for leg/feet, and/or back pain.

What is the purpose of it?    
A block is performed to determine if there is damage to the sympathetic nerve chain and if the damage is the source of pain.  Primarily, this is a diagnostic test, but it may provide relief far in excess of the duration of an anesthetic.Also, (from UW Health site )The purpose of the nerve block is to find out if your sympathetic nerves are causing your pain.  A stellate ganglion block is a test to diagnose and treat sympathetic dependent pain in your hand, arm or shoulder.  The pain may come from the nerves in your neck near the spine.  These nerves control sweating, heart rate, blood vessels, pupil dilatation, movement of food through the intestines, and many other body functions.  Sometimes these nerves do not work right and cause pain.  It can be on either side of your body.The injection blocks the Sympathetic Nerves.  This may, in turn, reduce pain, swelling, color and sweating changes in the lower extremities and may improve mobility.  It is the treatment for Reflex Sympathetic Dystrophy Syndrome (RSDS), Sympathetic Maintained Pain, Complex Regional Pain Syndrome (CRPS) and Herpes Zoster (shingles) involving the lower extremities.How long does the injection take?

The actual injection takes only a few minutes.

What is actually injected?

The injection consists of a local anesthetic (similar to lidocaine or bupivacaine); Epinephrine (adrenaline) or Clonidine may be added to prolong the effects of the injection.

Will the injection hurt?
The procedure involves inserting a needle through skin and deeper tissues (similar to a tetanus shot); there will be some dicomfort involved.  However, the skin and deeper tissues can be numbed with a local anesthetic using a very thin needle before inserting the larger needle for the block.  Most patients also receive intravenous sedation and analgesia, making the procedure easier to tolerate.

Will I be “put out” for this procedure?

No. This procedure is done under local anesthesia.  Most patients also receive intravenous sedation and analgesia, making the procedure easier to tolerate.  The amount of sedation given generally depends upon the patient’s pain tolerance.

How is the injection performed?

The injection is performed with the patient either in a seated position or lying on their back.  Using Fluoroscopy (X-ray) , the Dr will guide the needle(s) into the proper position, near the front of the neck,  and then the injection is performed. The patient will also be monitored with EKG, a blood pressure cuff, a blood oxygen monitoring device and temperature sensing probes placed on the feet.  

What should I expect after the injection?

Immediately after the injection, the patient may feel their lower extremities warming and the pain lessening or gone.  Some weakness and/or numbness may also be felt, but is temporary.

What should I do after the procedure?

The patient should have someone drive them home. The patient should perform as little as possible for at least a day or two after the procedure; or as tolerated based on the individual.  Some patients immediately follow the procedure with physical therapy.

How long will the effect of the medication last?

The local anesthetic wears off in a few hours.  However, the blockade of sympathetic nerves may last for many more hours.  Usually, the duration of relief gets longer after each injection.

How many injections do I need to have?

If you respond to the first injection, you will be recommended for repeat injections.  Usually, a series of such injections is needed to treat the problem.  Some may need only 2 to 4 and some may need more than 10.  The response to such injections varies from patient to patient.

Will the Sympathetic Block help me?

It is very difficult to predict if the injection(s) will indeed help you or not.  The patients who present early during their illness tend to respond better than those who have this treatment after about six months of symptoms.  Patients in the advanced stages of disease may not respond adequately.

What are the risks and side effects?

There are always risks, side effects and possibility of complications with any procedure.

For the first few hours, you can expect any of these to occur on the side of the body where the test was done.

  • Watery, red eye
  • Dilated pupil
  • Droopy eyelid
  • Droopy face
  • Hoarse voice

Expect some soreness at the injection site for the next 2-4 days.  

Who should not have this injection?

If you are allergic to any of the medications to be injected, if you are on blood thinning medications (e.g. Coumadin®, Plavix®, Ticlid®), or if you have an active infection going on near the injection site, you should not have the injection.

Information courtesy of Redding Anesthesia Associates Medical Group

Videos of Different Types of Cervical Blocks

A cervical selective nerve block is an injection designed to help relieve neck pain, shoulder pain, and/or arm pain caused by a pinched nerve or nerves in the cervical spine.