The Procedure Guide

1-Minute Lumbar Medial Branch Block


01 8cc local anesthetic in 10cc syringe

02 Bent 22g (3.5" or 5") Quincke Needle

03 3-5cc 1% lidocaine in 5cc syringe with 25g x 1.5" hypodermic needle

04 Radiopaque pointer 

Create a Pointer


Use the longest option that you have, here a 20cc syringe and needle are used (cap on to prevent pokes).

Draw up meds


Small syringe for subq lidocaine and larger syringe for injectate at each level.

We'll treat L4, L5, sacral ala, then L3

We're treating in this order since all targets are accessible from an entry above L4

Get a scotty dog view of L4


Level off L4 (red), look down the facet joint (blue)

Find Insertion Point


The pointer is over the ideal insertion point, just lateral to the L4 SAP/TP junction.

Anesthetize and direct to target


Aim to contact bone at the L4 SAP/TP junction. Then inject medication

Level off L5


Tilt the C-arm (probably the top towards the head) to level off L5

Redirect needle to L5


From the L4 target, pull the needle out partially, aim inferior, direct till contacting bone at the L5 target. Inject.

Repeat steps 7 and 8...


Here, we repeat the steps for the sacral ala

Repeat steps 7 and 8...


Here, we repeat the steps for L3

Check a lateral


Often this isn't needed, but this can confirm depth and proper placement

One insertion point

Note the single insertion point on the skin for more patient comfort

Little C-arm movement

Usually 4 AP views and 1 lateral view are sufficient. 1 minute procedure time. NICE JOB!

Lumbar Medial Branch Block

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