- Joined
- Apr 2, 2010
- Messages
- 375
- Reaction score
- 134
Patient on apixaban and plavix. Would you continue for procedure?
1. Assuming unilateral dermatomal distribution of pain.Why do TFESI instead of interlaminar?
There’s a local guy who did an accidental arterial injection using TFESI in the thoracic region, used Kenalog of course….major lawsuit for spinal cord injury going on right now
PE/DVT and CADIf it's PHN, an ESI is reasonable IMO.
What's the reason for the anticoagulation?
I'd do it off Plavix but on apixaban. TFESI.
I'm thinking this would be most reasonable. Would you do them with above AP/AC on board?Intercostal. Omoigui diffusion technique.
For sure. Especially diffusion technique since you’re just landing on the superficial side of the rib. Easily compressible. Also I think I’m about 0 for 5 with thoracic epidurals helping with PHN…I'm thinking this would be most reasonable. Would you do them with above AP/AC on board?
Just saw pt. Just had 2 cardiac stents placed last month so no way can come off Plavix. And had PE/DVT during same hospitalization so same goes for apixaban.TFESI IMO
Are people still doing series of 3 for these? What's your cocktail if you don't mind me asking, Steve?Intercostal for PHN and get it by the DRG.
2 level unless 1 clear band. 2cc bup 0.25% and 5mg 0.5ml dex.Are people still doing series of 3 for these? What's your cocktail if you don't mind me asking, Steve?
Why center of rib though? Easy enough to touch inferior aspect safely, especially with caudal tilt, it's the walking off that gets riskier. Would seem like you'd more likely diffuse to intended target if starting closerMark off a rib in the approximate center of the pain, drop a 25g onto the center of the rib shadow until it touches bone. Put a finger on each side of the needle oriented cephalad/caudad, and apply pressure to constrain the spread in a superior/inferior direction, and inject about 10 mL lido/steroid.
Minimize risk. Definitely more diffuse - I’ve added contrast to it to see, and one shot hits 2-3 intercostal levels.Why center of rib though? Easy enough to touch interior aspect safely, especially with caudal tilt, it's the walking off that gets riskier. Would seem like you'd more likely diffuse to intended target if starting closer
YesYall use flouro?
Yall use flouro?
100%Yall use flouro?
So even with pressure superior and inferior to rib, you get spread to adjacent levels? I guess that makes sense with 10cc.Minimize risk. Definitely more diffuse - I’ve added contrast to it to see, and one shot hits 2-3 intercostal levels.
No, I hold pressure lateral and medial to the needle so the medication spreads superior and inferior.So even with pressure superior and inferior to rib, you get spread to adjacent levels? I guess that makes sense with 10cc.