Advice after your nerve block for surgery
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Introduction
We have given you this factsheet because you have an appointment for a radiology
investigation called a fluoroscopic-guided lumbar puncture. Please make sure you read this information and follow the instructions carefully before your procedure. If you have any further questions, please speak to a member of your healthcare team who will be able to advise you.
A lumbar puncture (LP) is the insertion of a small needle into your spine so that a sample of the fluid that surrounds the brain and the spinal cord can be obtained for testing. The fluid is called cerebrospinal fluid (CSF) and is constantly replenished; when a small sample of this fluid is taken it is rapidly replaced. The procedure in radiology uses fluoroscopy to guide the needle into the correct position. Fluoroscopy is a process that uses X-rays to produce a real time moving image on a television monitor.
Before your appointment
Please let us know if:
- you are taking any medication which impair the bloods ability to clot (anticoagulation or blood thinning drugs) e.g. anticoagulants such as warfarin, dabigatran, rivaroxaban or heparin, anti-platelet drugs like Aspirin, clopidogrel and dipyridamole, or if you have a coagulopathy, abnormal bleeding or clotting disorder (bleeding disorders).The radiologist who will be performing your examination can be notified and may need to discuss this with you and your hospital consultant before your appointment can be confirmed as the medication may need to be stopped or changed before the procedure
Please let us know if:
- there is any possibility that you may be pregnant. All patients from 12-55 years of age (regardless of gender) who will undergo a Radiology procedure will be asked about the possibility of them being pregnant.
- you have limited mobility and / or requiring a hoist
- you will need an interpreter. We are not able to use family members or friends to interpret.
In order to make your appointment run more smoothly, please let us know if any of these apply, in advance, by calling our bookings team (contact details are displayed on the main Radiology page).
On the day of procedure
There is no preparation for this examination, you may eat and drink normally. Continue to take your normal medication unless otherwise instructed. It is advisable not to drive yourself to the appointment.
On Arrival
Please arrive 10 minutes before your appointment time.
The Radiology / X-Ray Department is located on the ground floor of the hospital. You should follow the directions from the main hospital entrance. On arrival in the department you should check in at the reception desk. Bring this letter with you and be prepared to confirm your details with the receptionist. Please allow time to do this prior to your appointment time and bear in mind that the reception may be busy. Once you have been booked in you will be directed to the waiting area. Please be aware that patients are attending for different examinations and patients who arrive after you may be called before you. The Radiology Department can be very busy, please bring only one relative or friend with you.
The Examination
Referral and consent
The procedure will be explained to you by the radiologist (doctor specialising in medical imaging). You will be able to ask any further questions that you may have. You will be asked to sign a consent form confirming that you understand the procedure and are aware of the risks and benefits involved.
Procedure
Your procedure will be performed by a radiologist who will be working in a team with a radiographer and a nurse.
- Once called, you may be asked to change into a gown.
- You will either be asked to lie on your side with your knees curled up to your stomach or asked to sit on the side of the bed, bending forward. A nurse may help you tuck your head toward your chest.
- Everything will be kept sterile and the radiologist will wear sterile gloves. Your skin will be cleaned with antiseptic solution and sterile drapes will be placed over this area. Then your skin will be numbed with local anaesthetic. When the local anaesthetic is injected, it will sting to start with, but this soon wears off, and the skin and deeper tissues should then feel numb.
- The doctor will carefully put a needle into a space in the lower back, below where the spinal cord ends. You will need to hold very still so that the needle does not move. You may feel some pushing as the needle enters your back, please tell your doctor if you feel pain.
- The pressure of the CSF may be assessed before a sample of your spinal fluid is taken and will be sent to the laboratory for testing.
- A small dressing will then be put on your back.
After the Examination
You will be asked to lie flat for 30 minutes after your lumbar puncture and after that you will be free to go home.
Please drink plenty of fluids to help reduce the chance of developing a headache. If you do experience a headache after the procedure, you can treat this by lying flat and taking simple pain relief medication such as paracetamol. Drinks containing caffeine may also help these symptoms.
The dressing from the lumbar puncture can be removed the following day.
Avoid strenuous activity for the first 24 hours after the procedure. You can return to all your usual activities such as work and driving, as soon as you feel well enough after that.
Risks
Headache
This is the most common side effect and is due to decreased pressure of the CSF following removal of the fluid. It can start a few hours to 2 days after the procedure, and last for a few days. It is caused by the slow leak of spinal fluid through the puncture site into the tissue. It is not dangerous and the leak closes over a few days. The headache may be dull or throbbing and you may also have a stiff neck and sickness. It can be treated by lying flat and taking pain relief medication such as paracetamol and drinking fluids containing caffeine.
Very rarely the headache can last several weeks or months and will need an injection to seal the lumbar puncture site.
Back pain
There may be soreness around the site from where the local anaesthetic injection and lumbar puncture needle was inserted and some bruising.
Tingling in your legs
These symptoms can occur during the procedure if the needle touches and stimulates a nerve root in the lumbar spine but will disappear after seconds when removed. Nerve damage after a lumbar puncture is extremely rare (1 in a 1000).
Infection / fever
There is always a risk of infection being introduced, as the needle has to go through the skin but this is extremely rare due to the cleaning of the skin and using aseptic techniques. If you get symptoms of infection like a fever, you must contact your doctor immediately.
X-rays
X-rays are a type of radiation. We are all exposed to natural background radiation every day from the sun, food we eat, and the ground. Exposure to medical X-rays carries a small additional risk, but your doctor feels that this risk is outweighed by the benefits of having the test and the amount of radiation you will receive is kept to as low as reasonably possible.
Contact us
If you have any queries relating to this information, please contact the Radiology service.
About this information
Service:
Radiology
Reference:
PILS-IR.4
Approval date:
3 October 2024
Review date:
3 October 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.