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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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PEARLS

The single most important word of advice about facet blocks is that they should be used selectively after a thorough history is obtained and a physical examination is performed, both of which are directed at the patient’s pain complaints. Radiographic and neurodiagnostic studies are necessarily integrated with the patient’s signs and symptoms. Heeding this advice allows the anesthesiologist to be more precise when performing facet blocks and minimizes frustration over any lack of diagnostic or therapeutic results. Also, to use facet blocks effectively it is important to understand the innervation of both lumbar and cervical facet joints. Such an understanding helps minimize diagnostic confusion.

Another factor in this regard is to become comfortable with radiocontrast agents and their use near the neuraxis; again, Hypaque M-60 is currently the preferred agent. It is also important to remind oneself and one’s colleagues constantly that radiographic changes in the facet joints have never been effectively linked to specific facet pain states. If large volumes (4–5 mL) of therapeutic solutions are injected at the lumbar facet joints, the results may be difficult to interpret because the solution is not contained within the facet joint but spreads to the segmental nerves and the paraspinous muscles. Finally, I believe it is important to warn patients that neuraxial block effects are possible (although rare) after facet injections; thus, the blocks should be performed only when complete stabilization or resuscitation of unintentional postinjection effects is possible.

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