g. Sacroiliac Joint Injection
- What is the sacroiliac joint, where is it located, and what is its function?
The sacroiliac joint is a joint located between the spine and the pelvis. It connects these two bones to each other. It is also the attachment site for many muscles in the area.
Anatomy of the sacroiliac joint
- In what situations is it applied?
• Various rheumatic diseases,
• Acute or chronic trauma causing inflammation of the joint,
• Pain caused by pressure on the surrounding nerves due to fluid accumulation in the sacroiliac joint following various viral diseases.
- What is a sacroiliac joint injection, what is its purpose, and how does it work?
• A sacroiliac joint injection involves injecting a mixture of local anesthetic and steroid into the sacroiliac joint. The purpose of the injection is to reduce the increased fluid or edema inside the joint, thereby reducing pressure on the nerves, as well as directly blocking the nerves.
- What preparation is required for the procedure?
- No food or drink should be consumed 4 hours before the procedure. However, you should take the medications your doctor has permitted you to continue with a small amount of water. Inform your doctor about any drug allergies during your initial visit. Come without wearing any jewelry such as necklaces, earrings, watches, rings, or bracelets. Because of the effects of the sedation applied during the procedure on mental functions and the effect of the local anesthetic applied to the procedure area causing weakness in the legs, you are not allowed to drive. Therefore, you should come with a relative who can accompany you after the procedure.
- What are the benefits of the procedure? Generally, pain begins to decrease within 15-20 minutes after the procedure. It has the benefit of eliminating inflammation and edema in the area.
- How is it administered? Before the procedure, you will be required to sign an informed consent form as a legal requirement. After a vein is accessed, the patient is taken to conditions similar to an operating room, and measurements of pulse, blood pressure, oxygen levels, and respiration are taken. These values are continuously monitored throughout the procedure.
The patient lies face down, and if necessary, a pillow can be placed under the abdomen. Then sedative drugs are administered through the vein. The area is cleaned and draped with antiseptic solutions. The entry point of the needle is then identified and verified using imaging equipment. After the entry point is numbed with a local anesthetic, the imaging equipment is used again for verification after administering a contrast agent, and the local anesthetic and steroid mixture are injected to perform the block. The patient is then taken to the room and monitored for about 2 hours. After the observation period, the patient is sent home with an accompanying relative.
Sacroiliac joint blocks
- What can happen after the procedure, and what are the benefits?
There may be pain at the needle entry site, which generally responds to analgesic treatment. Penetration into the vessels in the intervention area can cause bleeding. But all these are extremely rare. If the imaging equipment is used correctly, these risks are almost non-existent. Immediate pain relief after the procedure is an indication of its success. Pain may decrease right after the procedure but may increase from the second or third day up to the seventh day. This pain is due to the procedure itself and can be easily controlled with prescribed pain medication. By the end of the first week, the treatment starts to settle, and there is a significant improvement in pain and other symptoms after about three weeks.
9.What is the purpose of the sacroiliac joint injection?
The purpose of the injection is to temporarily block the nerves in the area with a local anesthetic and to eliminate the edema inside the joint with the added depot steroid.
10.How long does the procedure take?
The procedure takes 15-20 minutes and is performed under operating room conditions. Since the patient is monitored after the procedure, the total hospital stay may be 3-4 hours.
- Is the procedure painful, is anesthesia administered?
Both the needle entry site is numbed, and sedative drugs are administered through a vein for sedation. Thus, you do not feel pain. Sedation is not general anesthesia. It only provides a brief period of memory loss and a pain-free period. There is no need for general anesthesia because the procedure is very brief.
- What should I do after the procedure?
Rest is recommended for 4-5 days after the procedure. You can attend to your needs like eating, using the toilet, and bathing. Besides these, you should rest continuously in a lying position that does not cause discomfort. Patients who are working are given a medical certificate to take time off work.
- Can I go back to work the day after the procedure?
A few days of bed rest are required.
- How long does the effect of the procedure last, how many times can it be repeated?
• The effect is usually long-term, and the pain might not return.
• If needed, the procedure can be repeated after 6 months.
- Can it have a permanent effect?
It has a chance of providing a long-term solution depending on the underlying cause of the pain.
- What should I watch out for after the procedure?
Watch for any signs of infection at the injection site such as redness, swelling, or fever. If you experience weakness in your legs or difficulty controlling your bladder or bowels, you should contact your doctor immediately.
- Is it covered by insurance?
It varies by insurance company and policy. Some insurance companies cover the procedure if it is deemed medically necessary.
- Risks and Side Effects
While the procedure is extremely safe, the risks, side effects, and potential complications that can be seen with all other interventions can also rarely occur with sacroiliac joint injections. The most common side effect is pain at the site of intervention, which is temporary. Other risks include bleeding, infection, and accidental injection into surrounding vessels or organs. These side effects are exceedingly rare.
- Who should not receive a sacroiliac joint block? The procedure should not be performed on individuals who have an allergy to the medications used during the procedure, those who are taking blood thinners such as Coumadin or Plavix, or patients who have an active infection in any part of their body or at the site of the procedure.
