Sacroiliac Permanent Block

What are sacroiliac permanent blocks?

The sacroiliac joints are found in your lower back on the left and right hand sides. These joints are located in the pelvis between the ilium of the pelvis (number 2 in Figure 1) and the sacrum (number 1 in Figure 1). The sacroiliac joint can be the cause of your pain; as a result of osteoarthritis for example. A needle can be inserted into the sacroiliac joint (number 3 in Figure 1) in order to inject drugs. There are also small nerves that are important in passing on pain signals from the sacroiliac joint. By heating of these small nerves can be blocked so that the sacroiliac joint is no longer painful.

pelvisN

Figure 1. The pelvis seen from the back (see text).

What should I be aware of before undergoing sacroiliac permanent blocks?

Any of the following situations should be reported to your pain specialist if he proposes sacroiliac permanent blocks:

  • If you are pregnant: since X-Ray equipment is used, pregnant women may not undergo sacroiliac nerve blocks.
  • If you are ill or have fever on the day of treatment you cannot undergo sacroiliac nerve blocks and a new appointment has to be made.
  • If you are allergic to iodine, bandages, anaesthetics or contrast fluids, you should notify your pain specialist before the appointment for treatment is made.
  • If you are taking blood thinners, you should notify that your pain specialist before the appointment for treatment is made. He will then consider whether the use of certain medications should be ceased temporarily.

How should I prepare for sacroiliac blocks?

  • No special preparations, such as an overnight bag, are necessary because the treatment is carried out on an outpatient basis.
  • You may eat before treatment and take your normal medication.
  • N.B.: this does not include blood thinners, as mentioned above.
  • Make sure you have someone to take you home, because you may not drive for 24 hours.

How do the sacroiliac permanent blocks work?

  • The treatment will be performed in the surgical day-care centre, where you will be asked to change into a surgical gown. This gown closes at the back.
  • A nurse will escort you to the treatment room, where there is a treatment table, an X-ray machine and television monitors.
  • For a sacroiliac nerve block you will positioned on the treatment table on your stomach.
  • With the help of the X-ray machine and a metal ruler the exact location of the sacroiliac nerve block is determined.
  • This place is marked on the skin with a felt pen.
  • The area around this site is then disinfected with a cold, red liquid.
  • The pain specialist covers the area with sterile drapes.
  • After local anesthesia of the skin the pain specialist will bring under fluoroscopy (via television monitor) the needles in the correct place.
  • Some contrast fluid is also injected to enable the position of the needle to be clearly visible.
  • Then small electrical currents are administrated near the ganglion.
  • Then small electrical currents are administrated near the nerve.
  • You will feel a tingling sensation.
  • When you feel this, you must tell the treating pain specialist straight away, and not wait for it to become painful.
  • The pain specialist will ask you where you feel the sensation and you don't have to point the place with your finger.
  • By means of a special device, the pain specialist can read the distance from the needle to the nerve.
  • If the needles are in the right place a radiofrequency electrical current is administrated trough the needle to block the sacroiliac nerves.
  • You will then be asked to get dressed and make an appointment at the pain clinic after six weeks with your own pain specialist.
  • The effect of treatment will be checked and further policy will discuss with you.
  • On the day of the treatment you should slow down and is advised not to participate for 24 hours in traffic.

What are dangers and side effects of sacroiliac permanent blocks?

  • Sometimes an allergic reaction for the injected substances such contrast fluid can occur.
  • As possible side effect of sacroiliac blocks a temporary numbness of the skin at the side of the treatment can occur.
  • Touching of the skin in this area can be unpleasant and painful.
  • It will disappear after a few weeks.

When can I expect pain relief after the treatment?

  • After pains can occur following sacroiliac block. These may last for several weeks but will eventually disappear.
  • The optimum results of treatment are seen after six to eight weeks.
  • Around this time, a new appointment with your pain specialist will be made.