X-ray guided nerve root block - Royal Devon & Exeter Hospital

Consent to treatment:Nerve root block injection(Please fill this out before attending and bring with you)NameDate of birthWhat is a nerve root block?A nerve root block is an injection of local anaesthetic and steroidaround one of the nerves in your spine. It is carried out with the aidof an x-ray. The aim is to see if your leg pain can be relieved.You will need to bring someone with you to hospital to stay with youand drive you home afterwards. It would be best if that person couldstay with you for a while when you get home.Why do I need a nerve root block?■■I have read and understood this information booklet including thereasons for this test and the potential complications.Other tests usually an MRI scan will have shown a swollen discpressing on a nerve. This is likely to be causing pain in your leg.■■■■I consent to this examination (nerve root block injection).I understand this will be kept as a record on the radiologyinformation system.SignedPrint nameDateWho has made the decision?The consultant team and/or specialist physiotherapist in charge ofyour case will have referred you on to the radiologist carrying outyour nerve root block. If after discussion with the radiologist youdecide you do not want the test you can decide against it.What are the alternatives?The alternatives will include: doing nothing, physiotherapy and painrelief. Occasionally surgery to repair a disc is appropriate this will bediscussed with you.- 8 -- 1 -