Pain Management Procedures
Sacroiliac Lateral Branch Blocks and RFA
Sacroiliac Lateral Branch Blocks and Radiofrequency Ablation
What are these procedures?
Small lateral branch nerves carry pain signals from the back portion of the SI joint and its supporting ligaments. A diagnostic block places numbing medicine beside these nerves. If the usual pain improves substantially for the expected anesthetic period, RFA may be used to interrupt the signals for a longer time.
When may they be recommended?
These procedures may be considered for chronic SI-region pain that has not improved enough with activity modification, medication, and targeted rehabilitation. The history, physical examination, imaging, and response to an SI-joint injection or lateral-branch block may all be considered. Insurance policies differ significantly on coverage and required diagnostic steps.
What happens?
You lie face down while fluoroscopy or another imaging method guides needles to the sacral lateral branches and often the L5 dorsal ramus. For the block, a small amount of local anesthetic is injected at each target. During RFA, the clinician confirms position, numbs the area, and applies controlled radiofrequency energy through specialized needles.
Recovery and results
A diagnostic block is brief by design. After RFA, soreness, numbness, or a sunburn-like feeling over the buttock can occur. Benefit may take one to three weeks and may last several months. Nerves can recover, so symptoms may return.
Important risks
Risks include bleeding, infection, medication reaction, temporary numbness, increased pain, and uncommon nerve injury. RFA treats pain signaling but does not fuse or stabilize the joint. Continued strengthening and movement work may remain part of the plan.
Preparing for your injection procedure…
Your instructions will depend on the procedure. Before any injection, tell the APG team if you:
Take aspirin, warfarin, clopidogrel, apixaban, rivaroxaban, or another medicine or supplement that affects bleeding. Never stop a prescribed blood thinner unless the clinician who manages it and the procedure team tell you how to do so safely.
Have diabetes, glaucoma, a bleeding disorder, an active infection, fever, or recent antibiotic treatment.
Could be pregnant, have an allergy to contrast dye or local anesthetic, or have reacted to steroid injections before.
Use an implanted pacemaker, defibrillator, spinal cord stimulator, or other electrical device.
Some procedures require fasting, a medication adjustment, or a responsible adult to drive you home, especially when sedation is planned. Follow the instructions provided for your specific appointment.
After your injection procedure…
Most injections are outpatient procedures. Mild soreness, bruising, temporary numbness, or a brief increase in the usual pain can occur. Follow the activity and bandage instructions you receive. Steroid medicine may take several days to have an effect and can temporarily raise blood sugar.
Call the office promptly for increasing redness, drainage, fever, severe or rapidly worsening pain, or new numbness or weakness. Seek emergency care for trouble breathing, chest pain, sudden loss of bladder or bowel control, a severe new headache, loss of vision, stroke-like symptoms, or rapidly progressing weakness.
This information is for general education and does not replace medical advice, diagnosis, or treatment. Not every procedure is appropriate for every patient, and results vary. Your APG care team will review your symptoms, examination, imaging, medical history, medications, and prior treatment before recommending a plan. Coverage requirements also vary by insurance plan.