Costovertebral Block

Different types of spinal injections carry different risks. Your doctor will explain the specific risks of your procedure. These potential risks are common to many spinal injections:

• Nerve problems that cause arm or leg weakness
• Increasing feelings of numbness
• Briefly increased pain or severe increased pain
• Incontinence
• A type of post-injection headache (“spinal headache”)
• Bleeding, infection (rare)
• Stroke
• Spinal cord injury

Costovertebral blocks and joint injections can provide a variety of benefits to individuals suffering from upper back pain:

• May relieve or diagnose pain
• Is less invasive than surgery, fewer risks
• Allows fast recovery
• Does not require a hospital stay

The actual costovertebral injection takes only a few minutes, but plan on 30 to 60 minutes for the whole procedure. You will remain awake and able to communicate the entire time. Your procedure will include:

• Monitoring. You may have devices attached to you to check your heart rate and breathing.
• Sedative. You may be given a sedative to help you relax.
• Position. You may lie face down, face up, or on your side.
• Local anesthetic. You’ll be given a local anesthetic near the injection site to numb the skin. This usually feels like a pinprick with some burning and only lasts a second.
• Fluoroscopic x-ray guidance. The doctor may inject a contrast dye that helps identify specific parts of your spine and confirm correct needle placement.
• Injection. Numbing medicines or anti-inflammatory medicines (steroids) will be injected into your spine.

After the costovertebral block procedure, you may stay in a recovery area and have your vital signs (heart rate, blood pressure, breathing rate) monitored. You should be able to walk immediately after the procedure, although some patients experience leg weakness, numbness, or tingling for a few hours. You may be asked to fill out some paperwork before leaving.

These are things to be aware of as you’re recovering from your costovertebral block at home:

• Driving. Someone may need to drive you home after the procedure. Your doctor will likely allow you to resume driving the next day.
• Possible side effects. You may experience briefly increased pain, headaches, or trouble sleeping. These should go away in the first few days.
• Food and drink. You may be asked not to eat or drink for a few hours.
• Activity. You may be asked to take it easy on the day of the injection. But it may help to get up and move around every hour or so. You should be able to resume normal activity the next day. Walk around if you feel up to it, but avoid activities that may strain your back.
• Showering and bathing. You can take a shower, but avoid baths or pools for 48 hours.
• Returning to work. Ask your doctor when you can return to work.
• Follow up. Be SURE to follow up with your doctor in two weeks or as otherwise instructed.

A costotransverse or costovertebral joint injection can provide relief from pain in the ribs or upper back by applying medication into the joints between the ribs and spine. A type of nerve block, a costovertebral joint injection may also be used to diagnose sources of pain.

Facet joint injections, including costovertebral injections, are given where two vertebrae join together. These joints allow the spine to bend and twist. Facet joint injections can decrease inflammation caused by arthritis and joint degeneration.

Before a facet joint injection, you may be given a diagnostic injection called a medial branch block near a nerve leading from the facet joint. This helps determine if a facet joint injection might relieve your pain. Your doctor may also recommend a radiofrequency neurotomy [noo-rot-uh-mee], which disables a spinal nerve so it can no longer send pain signals.

You might need a spinal injection if you have back pain that has not responded to physical therapy or other treatments. An alternative to back surgery, spinal injections can be used to:

• Diagnose your pain. Your doctor will inject numbing medicine (anesthetic) into 1 or more specific areas of your spine, blocking all feeling in those areas. If the pain is relieved, the doctor will better understand the source and how to treat it. If not relieved, then there may be a different source that may require more or different types of injections for a sound diagnosis.
• Relieve your pain. Your doctor can use spinal injections to relieve your pain, reduce swelling, or improve mobility. An anti-inflammatory medicine, such as cortisone, is injected directly into the place the pain comes from. Depending on the medicine injected, you may feel pain relief right away, or it may take a few days or more to take effect. Pain relief may be temporary (lasting several weeks or months) or long lasting.

What kind of pain relief can I expect?

If your injection is for diagnosing pain, you should feel relief right away from the anesthetic, but the relief will end in about an hour or so. You may need more than one injection for the doctor to diagnose the pain.

If your injection is for reducing inflammation and relieving pain, it can take a few days, or even a week, to feel relief. Your pain will go away slowly and steadily.

The injection may not relieve all your pain, but it may relieve enough of the pain to allow you to move around more easily. This can help you recover faster.

How long you can expect pain relief to last depends on how many areas are injured and the amount of inflammation you have. Some people may need more than one injection to feel relief.