splanchnic nerve block

[sweetalkr]

had a 45 y/o otherwise healthy dude with chronic LUQ pain s/p colectomy for a splanchnic today. guy is cool, no problems, procedure going great. i touch periosteum on T11 and dude got severe pain. needle in perfect position but pt could not tolerate me moving the needle. we re-scheduled the procedure for the OR with sedation, but just curious. Any thoughts with these sympathetic blocks? any tips? is this common? do you commonly use sedation or keep them awake?

I have done a few of them. one was scheduled with sedation, the other 2 without. the pts hurt on periosteum, but not like this dude. and needle was in right position, etc.

any thoughts help thanks

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[clubdeac]

sweetie, yeah a lot of times skiving the periosteum is painful as **** for most. You've got several options. Use a blunt 7" needle with introducer. Drop some local right on the periosteum every few cms. Or knock 'em out. I have patients that can handle it w/o any of the above sometimes they just can't handle it. windup at its finest. Just ask yourself, what would Gabor do? Or better yet, just ask him yourself

 

[lobelsteve]

Once a pass by the foramen (on lateral), I remove the stylet and inject lidocaine as I advance to the anterior body. No sedation, no pain.

 

[PainMD23]

Agree that periosteum very painful. I sedate them and find that when I strike periosteum, they always have a response. Agree with lidocaine for periosteum. I like the Chiba biopsy needle with introducer for the splanchnics (used in fellowship) but I don't think that the blunt needle is that much better tolerated without lidocaine (the unsedated patients I had in fellowship did not tolerate without lidocaine). I use 22 gauge 5 or 7 in my practice with lidocaine.

 

[Ligament]

yeah just blast the periosteum with lido and you are golden.

 

[sweetalkr]

thanks yall for the tips, especially clubdeac.. i miss you

seriously though I will try the lido on the periosteum.. not sure why my attending didn't mention that..

starting out my fellowship, all these tips are golden!!!