Bilateral Cervical MBB?

[perromaxfilm]

Hello,
In training we used to only due one sided cervical MBB for the theoretical risk of blocking bilateral phrenic nerves. For bilateral pain, we made patients pick a side. However, I have seen multiple private practice groups do just this. Is this an unreasonable risk? I only use 0.5 cc at each level and would only do 2 bilateral joints. For bilateral axial neck pain it would certainly save many patients multiple visits and copays. It would also make the patient's reported relief much more clear. Thanks.

 

[lobelsteve]

Not a reasonable risk and not a common complication.

 

[bedrock]

Agree with steve. The risk is theoretical and I've never seen it in a decade of doing this. Bilateral cervical MBB are the way to go.

 

[SommeRiver]

I don't do bilateral cervical MBB bc I have had pts become vertiginous.

Phrenic nerve anesthesia is a tough sell for me...I reject that.

 

[bedrock]

I don't do bilateral cervical MBB bc I have had pts become vertiginous.

Phrenic nerve anesthesia is a tough sell for me...I reject that.

I should have added the caveat that I don't do blocks of TON,C3 bilaterally because of that issue.
However that isn't a problem lower in the c spine and so you can do C4-C7 bilateral MBB all day long and the patient shouldn't have any more side effects than a bilateral lumbar MBB.

 

[oreosandsake]

or learn how to do them under ultrasound and see the nerve you are blocking...

you'd be surprised how many arteries are in the areas around the facets that are not found in Netter's

but i agree, I dont see any issue with Bilat CMBB. i do them from a lateral approach even if we burn from posterior to anterior

 

[callmeanesthesia]

Just look at the cross sectional anatomy - it’s a long way from the medial branch to the phrenic nerve, across multiple tissue planes. I just don’t see it happening.
related note: I’ll do bilateral C2-3 but I warn them extensively about dizziness, and use lidocaine instead of bupivacaine for the first one. Most tolerate it well. A few get really dizzy then we just do the RF one side at a time.

 

[Ferrismonk]

or learn how to do them under ultrasound and see the nerve you are blocking...

you'd be surprised how many arteries are in the areas around the facets that are not found in Netter's

but i agree, I dont see any issue with Bilat CMBB. i do them from a lateral approach even if we burn from posterior to anterior

CMBB cpts are not paid under ultrasound. LCD requires flouroscopy

 

[oreosandsake]

CMBB cpts are not paid under ultrasound. LCD requires flouroscopy

Use both

 

[Ducttape]

as long as you dont bill for the US...