Nerve Interventions

These injections target spinal nerve roots where they exit the spinal canal. The procedure involves delivering local anaesthetic and sometimes corticosteroid medication to the affected nerve root under imaging guidance. Nerve root blocks can provide both diagnostic information about the source of pain and therapeutic benefits by reducing inflammation around the nerve. They are commonly used for radicular pain patterns such as sciatica.

This technique uses heat generated by radiofrequency waves to create a controlled lesion on the nerve, disrupting pain signal transmission. A specialised needle is positioned adjacent to the target nerve under imaging guidance, then a radiofrequency current generates heat at the needle tip. RFA provides longer-lasting relief than nerve blocks and is frequently used for facet joint pain and other chronic pain conditions.

Unlike conventional RFA, PRF delivers short bursts of radiofrequency energy with cooling periods in between, modifying nerve function without creating a thermal lesion. The procedure uses similar equipment to RFA but applies energy differently to avoid permanent nerve damage. PRF may be preferred when treating mixed sensory and motor nerves or when preserving nerve function is particularly desirable.

These procedures target the coeliac plexus, a network of nerves in the upper abdomen that transmits pain signals from abdominal organs. Under imaging guidance, needles are positioned near the coeliac plexus for injection of local anaesthetic (block) or neurolytic agents like alcohol (neurolysis). These interventions are particularly effective for pain associated with pancreatic cancer and chronic pancreatitis.

These procedures interrupt the function of the sympathetic nervous system, which can become overactive in certain pain conditions. Depending on the target area, blocks may be performed on the stellate ganglion (neck), lumbar sympathetic chain (lower back), or ganglion impar (tailbone region). Sympathetic blocks often help diagnose and treat complex regional pain syndrome, vascular insufficiency, and certain neuropathic pain conditions.

This technique uses extreme cold rather than heat to temporarily disable nerve function and interrupt pain transmission. A specialised probe is positioned near the target nerve and rapidly cooled using gas expansion principles, creating an ice ball that affects the nerve. Cryoablation provides pain relief with potentially fewer complications than heat-based techniques and may be beneficial for treating peripheral nerve pain.

The skin over the procedure area is cleaned with an antiseptic solution. A local anaesthetic is then administered to numb the skin and deeper tissues at the needle entry site.

Fluoroscopy (real-time X-ray), ultrasound, or CT guidance is used to visualise anatomical structures and guide needle placement. Contrast material may be injected to confirm proper needle position near the target nerve. The choice of imaging technique depends on the specific procedure and anatomical considerations.

A specialised needle is advanced to the target nerve location. Once positioned correctly, the specific intervention is performed—medication injection for nerve blocks, application of radiofrequency energy for RFA/PRF, or extreme cold for cryoablation. For nerve blocks, the injected solution typically includes a local anaesthetic and may include other medications.

After completing the intervention, the needle is removed and a small dressing is applied. The patient’s response is assessed, checking for expected sensory changes in the targeted nerve distribution. Patients remain under observation for a short period before discharge with post-procedure instructions.