Injectable Meds

[takemypainaway]

Just got a shipment of a bunch of PF lido + epi. I've typically only used 2% plain for any injections (MBB, TPI etc). Any uses for lido + epi? Only used it in the past for peripheral nerve blocks for acute pain.

Is there standard for what steroid to use for CESI? Plan on using depo for lumbar IL ESI, dex for lumbar TF ESI. Have used celestone in the past for both CESI and TFESI.

In training we used to include steroid in our TPI, and I was laughed at in PP for continuing this practice. Hah.

TIA.

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[lobelsteve]

Lido with epi good for kypho and SCS to raise skin wheals as well as creating pockets and opening the midline for perms.

 

[BobBarker]

Use it in the epidural space if you want. Anesthesiologists do every day.

 

[lobelsteve]

Use it in the epidural space if you want. Anesthesiologists do every day.

Except this is pain and not anesthesia. We also don't dump fentanyl in there either.

 

[emd123]

Like Lobel said, anywhere you don't want bleeding/oozing and are going to cut/sew/stitch or make big holes.

Otherwise avoid in basic injections but only because it stings much more.

Also, don't use in areas of end-peripheral circulation like fingers/toes/penis/ears/nose although the importance of that may not be as great as we used to think (plastics often uses lido with epi in these locations).

 

[emd123]

Except this is pain and not anesthesia. We also don't dump fentanyl in there either.

...or induce complete sensory block from the umbilicus down. On a good day, anyways. Lol

 

[BobBarker]

Whether 2cc's of lido has 5mcg/ml epi or not isn't going to make any difference in an epidural

 

[Ducttape]

steve is saying that lido shouldnt be in a pain epidural...

 

[takemypainaway]

Thx all thats what I figured. Any input on steroids?

 

[BobBarker]

So you don't put any local in or is it marcaine?

 

[lobelsteve]

No role for local in ESI as no benefit. I will however dump in 2cc 2% PF lido if they are crying from an acute radic. Tears gets you lido, and a driver.

 

[ampaphb]

Steve is wrong. Of course there is a role. Local anesthetic bridges the time period prior to when you get a steroid effect.

In fact, in fellowship, Steve's fellows USED to use lido, marcaine, and steroid. He may have changed since I worked with him in '07, but in those days, the logic was that lido would address the immediate post-procedure pain, marcaine would bridge the ensuing hours, and then ultimately the steroid would kick in and provide longer term relief.

All of my patients come with a driver, or they wait till their motor and sensory are fully back to baseline.

 

[lobelsteve]

Steve is wrong. Of course there is a role. Local anesthetic bridges the time period prior to when you get a steroid effect.

In fact, in fellowship, Steve's fellows USED to use lido, marcaine, and steroid. He may have changed since I worked with him in '07, but in those days, the logic was that lido would address the immediate post-procedure pain, marcaine would bridge the ensuing hours, and then ultimately the steroid would kick in and provide longer term relief.

All of my patients come with a driver, or they wait till their motor and sensory are fully back to baseline.

We actually only recommended when Peter was injecting. 30 minutes for a TFESI and we used it to quiet the complaints of the patients that he speared.

 

[ampaphb]

Of course, if you are taught by a *****, what chance do you have of being better than the *****?

 

[emd123]

Hard to know the answer if the only hope is two *****s arguing as to what it might be.

 

[ampaphb]

Hard to know the answer if the only hope is two *****s arguing as to what it might be.

Of course, the only thing more annoying are inane, unintelligible comments from the peanut gallery. Best to be seen and not heard when the grown-ups are teasing one another.

 

[emd123]

Of course, the only thing more annoying are inane, unintelligible comments from the peanut gallery. Best to be seen and not heard when the grown-ups are teasing one another.

Intelligible? Unintellg8le? But Dj3&3ks ne99:&;&in What?