Removal of the Needle and Observation Period
After the injections have been completed, remove the needle. Next attach the catheter to the bacterial filter to the Stingray connector, assuring its sterility. The patient should be taken to the recovery room in order to evaluate motor function. This is done with a voluntary straight leg raise. If the patient test positive for a motor block (i.e. patient is unable to do the straight leg raise). STOP the procedure. This is an indication of a possible subdural spread.
Wait 20-30 minutes and if no motor block is present, place the patient with their painful side down and infuse 8-10 mL of local anesthetic before proceeding with the injection). Hypertonic saline is used for osmotic reduction of edema and disconnection of C fibers (sinuvertebral system) function.
After injections have been completed, withdraw the catheter from the patient (introducer needle should have been previously removed). Start neural flossing exercises as soon as possible.
One-Month Follow-up
During the one-month follow up visit it is common to see patients with pain-related facet joint arthropathy. these patients may need a diagnostic block followed by a cryoanalgesia or radiofrequency denervation of the facet joint.
Neural Flossing Exercises
Physical therapy is the next critical component to further ensure improved lasting recovery following medical intervention.
Healthy nerves should move freely within the body to ensure proper blood supply, fluid exchange, and nutrition. A healthful and effective method of renourishment is routine stretching and exercise.
Although results may not occur immediately, continued practice of these stretching exercises produces the best long-term outcome. Increased flexibility ad strength may emerge after one month. It is important that patients perform each individual exercise, or stretch, with increasing duration from 20-30 seconds. The exercises should be carried out two to three or more times a day with each session lasting no longer than three to five minutes. For chronic pain suffers, these exercises should be continued indefinitely to prevent the restriction of affected nerve roots and the resulting return of pain.
It's important to note that during the exercises, the patient's head should be flat on the floor without a pillow. Raising the head draws the spinal cord and attached nerves upward and can place a slight resistance inside the spinal canal. This resistance can further prevent the nerves from moving freely. Therefore, the three exercises are carried out in the fully flat, supine position.
Exercise 1
Lay down with your face up (supine) on the exercise mat without a pillow. Slowly, bring both knees close to the chest with bent legs and hold this position for 20-30 seconds. Release and assume a neutral position to rest briefly.
Exercise 2
Again, in the supine position, both legs are raised to a 90° straight-up position, with knees straight while laying flat on the firm surface. This position is held for 20-30 seconds. Assume a neutral position and rest briefly before the third and final stretching exercise.
Exercise 3
Similar to exercise 2, both legs are brought straight-up to a 90° position, while lying supine. Slowly spread the legs in a “V” shape, as much as is comfortably possible, and hold this position for 20-30 seconds. This exercise is extremely important because it reduces stress on the sciatic nerve.
*Repeat 3 Times Daily