Ankle blocks for DPN

[NJPAIN]

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Met a well trained doc who routinely performs bilateral ankle blocks (0.75% bup, betamethasone, ketorolac) for PN involving the feet. Reports several months of relief. Any similar experiences?

Early in my career pain management consisted of determining the sensory innervation of the area of complaint and then doing a “nerve block” with local anesthetic and steroid. Over time I’ve moved away from that but perhaps I need to reconsider?

 

[lobelsteve]

Dirty. No good science to support.

It looks like there is a problem accessing this site

 

[Orin]

There's a set of DPN patients that also have a super imposed entrapment neuropathy. They sometimes do well with injections or entrapment releases. I would not routinely chase that though.

If the HF10 data for DPN pans out tho, maybe more options coming.

 

[painfree23]

There's a set of DPN patients that also have a super imposed entrapment neuropathy. They sometimes do well with injections or entrapment releases. I would not routinely chase that though.

If the HF10 data for DPN pans out tho, maybe more options coming.

Ofc the HF10 data will pan out. It’s Nevro …it always works.

Also, I had this convo with my Nevro rep but a lot of these DPNs are not great stim candidates - can’t hold anticoagulant or a1c is like 9 or bad heart (can’t tolerate anesthesia). What do you recommend for these?

 

[lobelsteve]

Ofc the HF10 data will pan out. It’s Nevro …it always works.

Also, I had this convo with my Nevro rep but a lot of these DPNs are not great stim candidates - can’t hold anticoagulant or a1c is like 9 or bad heart (can’t tolerate anesthesia). What do you recommend for these?

None of those are significant risks or cannot be overcome. But will it work at 18 mo?

 

[painfree23]

None of those are significant risks or cannot be overcome. But will it work at 18 mo?

Can’t stop anticoagulant isn’t a significant risk?

 

[hyperalgesia]

Can’t stop anticoagulant isn’t a significant risk?

For an ankle block? No. The risk would be stopping the anticoagulant.

 

[lobelsteve]

Can’t stop anticoagulant isn’t a significant risk?

Can be overcome. Have not had issues holding coumadin or antiplatelet therapy. Have needed bridges for valve patients.