Alternatives to Cervical Epidural

[Dawkter]

Is anyone here attempting deep cervical plexus blocks, brachial plexus blocks, or cervical ESP blocks prior to scheduling a patient for CESI? It seems as though these are safer alternatives as the cervical epidural is risky and slowly falling out of favor among SOME pain physicians at society meetings.

Should we as a specialty be placing these other blocks higher in our treatment algorithm for cervical radiculopathy prior to ESI?

Cervical ESP

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[jsaul]

What will.a plexus block do for cervical radiculopathy

 

[Baron Samedi]

10 minute US guided procedure that pays nothing vs 2 minute fluoro procedure that is currently standard of care.

 

[Ducttape]

these are injections for pain that is transmitted through the brachial plexus, for example pain from arm or shoulder surgery

these are not injections for spinal stenosis or even cervical radiculopathy, where the nerve damage is proximal to where the brachial plexus block would target.

 

[willabeast]

Is anyone here attempting deep cervical plexus blocks, brachial plexus blocks, or cervical ESP blocks prior to scheduling a patient for CESI? It seems as though these are safer alternatives as the cervical epidural is risky and slowly falling out of favor among SOME pain physicians at society meetings.

Should we as a specialty be placing these other blocks higher in our treatment algorithm for cervical radiculopathy prior to ESI?

Cervical ESP

No offense intended, but in my hands a patient would be safer with a CESI than those other procedures you mentioned. Think it has to do with doing CESI, TESI and LESI over and over and over again for 40 years. I got a pneumothorax once with a trigger point injection. Walked the patient to the E.R. An R.N.!

 

[Asclepius186]

Maybe if the patient absolutely could not stop anticoagulant and they had a unilateral cervical radic I might consider it.

They are simple and easy. But they definitely have risks also. Risk of temporary phrenic nerve block in an older patient shouldn’t be overlooked either.

 

[GoBeers]

No offense intended, but in my hands a patient would be safer with a CESI than those other procedures you mentioned. Think it has to do with doing CESI, TESI and LESI over and over and over again for 40 years. I got a pneumothorax once with a trigger point injection. Walked the patient to the E.R. An R.N.!

how'd you know you caused PTX after TPI?
immediate onset chest pain, SOB, and pleurisy?

 

[Dawkter]

these are injections for pain that is transmitted through the brachial plexus, for example pain from arm or shoulder surgery

these are not injections for spinal stenosis or even cervical radiculopathy, where the nerve damage is proximal to where the brachial plexus block would target.

With an ESP block some medication does track into the PVB/epidural space.

 

[SSdoc33]

huh.

iv diagnosed at last 10 brachial plexopathies from "safe" brachial plexus blocks over the years. some with permament damage

 

[Ducttape]

With an ESP block some medication does track into the PVB/epidural space.

according to that study, only 1 level lit up consistently - C8. only 50% at T1, 10% at C4.

and they used 20 ml of volume to get that result.

 

[DrSpine]

Is anyone here attempting deep cervical plexus blocks, brachial plexus blocks, or cervical ESP blocks prior to scheduling a patient for CESI? It seems as though these are safer alternatives as the cervical epidural is risky and slowly falling out of favor among SOME pain physicians at society meetings.

Should we as a specialty be placing these other blocks higher in our treatment algorithm for cervical radiculopathy prior to ESI?

Cervical ESP

Who are these doctors and society meetings saying to stay away from CESIs because they’re dangerous? Never seen or heard that before.

CFTESIs are shied away from for obvious reasons, but there are still cases where surgeons request it. If you’re running a practice, unfortunately, it’s something you still have to do a couple times a week. In that case, I recommend you look it up and figure out how to do it as safely as possible. (This one isn’t a joke).

 

[Ducttape]

i would argue that bedrock's technique of feeding a catheter to the exact nerve root through an epidural is safer than a cervical TFESI...

 

[Ferrismonk]

Who are these doctors and society meetings saying to stay away from CESIs because they’re dangerous? Never seen or heard that before.

CFTESIs are shied away from for obvious reasons, but there are still cases where surgeons request it. If you’re running a practice, unfortunately, it’s something you still have to do a couple times a week. In that case, I recommend you look it up and figure out how to do it as safely as possible. (This one isn’t a joke).

I disagree. In my place there is no cervical TFESI no matter what the surgeon wants. Dangerous and not indicated.

 

[paindoc007]

Who are these doctors and society meetings saying to stay away from CESIs because they’re dangerous? Never seen or heard that before.

CFTESIs are shied away from for obvious reasons, but there are still cases where surgeons request it. If you’re running a practice, unfortunately, it’s something you still have to do a couple times a week. In that case, I recommend you look it up and figure out how to do it as safely as possible. (This one isn’t a joke).

Gross. Worst advise on sdn maybe ever

 

[DrSpine]

Gross. Worst advise on sdn maybe ever

I’m not big on TFESI or SNRB but I’ve done a small handful a year on a rare occasion. How is that the worst advice ever?

 

[SC Tian]

The patient had fusion at C6-C7, using C7-T1 approach, the contrast would not be able to pass the surgical site, you just squirted meds in no matter what, or you can identify the adjacent disease and treat it at the level of problem, imo.

 

[SSdoc33]

Gross. Worst advise on sdn maybe ever

wrong.

its bad advice, but there is a lot of bad advice on SDN

 

[SSdoc33]

The patient had fusion at C6-C7, using C7-T1 approach, the contrast would not be able to pass the surgical site, you just squirted meds in no matter what, or you can identify the adjacent disease and treat it at the level of problem, imo.

of course it would

 

[paindoc007]

wrong.

its bad advice, but there is a lot of bad advice on SDN

Name one worse

 

[SSdoc33]

Name one worse

do a quick search on doctodd. then read ANY of his posts (outside of his financial or fishing information. those are actually worthwhile). there you go.

 

[paindoc007]

I don’t care for politics at all. In terms of medical discussion and advice, which this forum’s purpose is, I dare you to find me one worse than that.

 

[Dawkter]

Who are these doctors and society meetings saying to stay away from CESIs because they’re dangerous? Never seen or heard that before.

CFTESIs are shied away from for obvious reasons, but there are still cases where surgeons request it. If you’re running a practice, unfortunately, it’s something you still have to do a couple times a week. In that case, I recommend you look it up and figure out how to do it as safely as possible. (This one isn’t a joke).

Here is the link below, topic was covered in a recent podcast.

Cervical Radiculopathy