bupivicaine

[medicineman1]

Thanks up front to any replies:

Question: I just started a project of sorts looking at bupivicaine and possible disc toxicity. How many of you use bupivicaine as it relates to procedures of the spine? How many possible scenarios can you come up where the disc may be exposed to bupivicaine?
-interlaminar
-transforaminal
-medial branch block?
-others?

Thanks again

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[SSdoc33]

ive seen several practitioners use it post-disco for pain relief. selective nerve blocks.

 

[stonemountain]

I also use it for facet joints, SI joints, hip joints. However, these are not near the intervertebral discs

 

[PMR 4 MSK]

Sympathetic block may give anterior exposure.

SNRBs often get some epidural absorbtion. I use .25% usually, although I might try .5% on a repeat if the first one failed to give pain relief.

Facet intra-articular can get epidural or even intrathecal exposure. I prefer lidocaine, though.

I stopped using bupivivaine in epidurals after using 1 cc .25% for a long time, then getting an obvious intrathecal response in one patient, despite no fluids on withdrawal prior to injection. Numbness rose to the arms. Scared the crap outta me as we brought the crash cart in and babysat her a while. She came through ok.

 

[Tenesma]

don't understand point of using bupivacaine --- it is way more expensive than lidocaine... and it may last an extra 1-3 hours...

from a chronic pain point of view, i don't think it is worth the effort

 

[Talos]

I use only use 0.5 % bupivicaine in intra-articular facet injections, SI joint injections and in some peripheral joint injections. I have never had a problem to date.

 

[medicineman1]

Are intradiscal injections still being done? Lit review is limited, but it seems its a technique from the past? There was an article in Radiology March, 2007 studying chemodiscolysis vs. steroid only Intradiscal and intraforaminal- so must be done somewhere?

 

[SSdoc33]

they are being done. search the old threads and you'll find a discussion about it and who's doing them

 

[Aether2000]

There is one practice in Mexico city that has performed over 10,000....as presented at the IITS meeting a few years ago...

 

[axm397]

Are intradiscal injections still being done? Lit review is limited, but it seems its a technique from the past? There was an article in Radiology March, 2007 studying chemodiscolysis vs. steroid only Intradiscal and intraforaminal- so must be done somewhere?

Dr. Goodman said he does them pretty frequently.

 

[Tenesma]

again

what is the advantage of using a more expensive, more toxic substance for a CHRONIC condition when the only real difference is a few extra hours of anesthesia????

 

[medicineman1]

Tenesma- I dont think anyone here is debating whether it makes sense or not to use it, just how much is it used out there vs. lidocaine? and where is it used? There are a couple of studies that show bupivicaine is toxic to chondrocytes, and at the lab I am at -some data suggests its toxic to nucleus pulposis and annular tissue tissue as well. If this turns out to be the case then it certainly doesnt make sense to use it.