What should I ask a patient who received a C5,6,7 medial branch block (MBB)?

Assessment After Cervical Medial Branch Block (C5,6,7 MBB)

After a patient receives a C5,6,7 medial branch block, you should specifically assess for pain relief, functional improvement, and any adverse effects to determine the procedure's diagnostic and therapeutic value.

Pain Assessment

• Ask about the percentage of pain relief experienced following the procedure (aim for at least 70-80% pain relief as this correlates with better outcomes for subsequent interventions) 1
• Inquire about the specific location of any remaining pain and whether it differs from the pre-procedure pain pattern 2
• Document the duration of pain relief, as this information is crucial for determining next steps in treatment 3
• Ask about changes in pain quality, intensity (using a numerical rating scale), and aggravating/relieving factors 1

Functional Assessment

• Assess for improvement in neck mobility and range of motion 2
• Inquire about ability to perform previously painful activities or movements 2
• Document any changes in daily activities, work capabilities, and quality of life 2
• For patients with cervicogenic vertigo symptoms, specifically ask about any improvement in vertigo symptoms, as MBBs can significantly improve these symptoms in approximately 62% of patients 4

Adverse Effects

• Ask about any post-procedure complications such as:
  • Temporary increase in pain at the injection site 5
  • Numbness or weakness in the arms 2
  • Headache or dizziness 4
  • Any unusual symptoms that might indicate complications 2

Treatment Response Evaluation

• If significant pain relief was achieved (≥70% with double MBB protocol), this suggests facet joint pain and potential candidacy for radiofrequency denervation 1, 2
• If minimal or no relief was experienced, this suggests the facet joints may not be the primary pain generator 3
• Document the need for pain medications before and after the procedure 1

Follow-up Planning

• Based on response, determine appropriate next steps:
  • For good responders (≥70% relief): consider radiofrequency denervation as the next therapeutic option 2
  • For partial responders: consider additional diagnostic workup to identify other pain generators 2
  • For non-responders: reassess diagnosis and consider alternative interventions 3

Important Considerations

• The volume of injectate used during the MBB can affect specificity - smaller volumes (0.25mL) may provide more specific diagnostic information than larger volumes (0.50mL) which can spread to unintended targets 6
• Some patients may experience prolonged relief from diagnostic MBBs alone, particularly those with unilateral pain and shorter duration of symptoms (<6 months) 3
• Ongoing assessment after treatment is essential to show evidence of response and guide further management decisions 2

Pitfalls to Avoid

• Don't assume that lack of pain relief means the procedure was technically unsuccessful - it may correctly indicate that the facet joints are not the primary pain generator 2
• Avoid relying solely on subjective pain reports; incorporate functional assessment into your evaluation 2
• Remember that the diagnostic accuracy of MBBs is dependent on proper technique and volume of injectate used 6
• Don't overlook the need for rehabilitation during periods of pain relief, as this can decrease the need for future interventions 2