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Diagnostic Procedures

Discussion in 'Pain Medicine' started by PainDr, Apr 24, 2007.

  1. PainDr

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    For those of you who offer IV sedation (versed/fentanyl) for theraputic procedures, does anyone allow versed during diagnostic procedures (MBB, discograms, SNRB, etc.)?
     
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  3. Mister Mxyzptlk

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    I'm not sure I understand the question. Is there a problem with using Versed for those procedures? I avoid narcotics for MBBs and discos because I want to assess them right away.
     
  4. PainDr

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    No...I don't think there's a problem with using versed. I only ask because I was recently talking with someone who was adament that it was inappropriate. His opinion was that no sedation of any kind should be used during diagnostic procedures. I just wanted to get some other opinions.
     
  5. lobelsteve

    lobelsteve SDN Lifetime Donor
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    I use Fentanyl and Versed at the patient's request for most any procedure.
    THe sedation is not the downside- I can control how out of it they are pretty easily. It's the 60min since last dose that clogs our recovery rooms that makes it less useful.

    THe counter argument also holds for discogram. When looking for the pain generator in a hyperalgesic, wound up patient with no sedation. THey get 10/10 skin wheals, 10/10 paraspinal muscle pain, then 10/10 disc pain at all levels.

    I would not allow a 3 level lumbar discogram to be performed on me without adequate sedation.
     
  6. Mister Mxyzptlk

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    I understand the question now. I try to do my MBBs w/o narcotic, just versed. I agree that a disco w/o something IV is on the barbaric side and I do use a little fentanyl for that.

    I don't think versed interferes with the diagnostic power of MBBs, although I do tend to wonder sometimes if it makes people hyperalgesic. There is literature to that effect. OTOH, maybe they just don't do as well w/o the fentanyl part of the cocktail and that's what I notice. Narcs smooth out a lot of wrinkles from an anesthetic.

    As for recovery time, we routinely use 1-2 mg versed and 50-100 mcg fentanyl for procedures and we don't have any problems getting them out of the office in 10-15 minutes.
     
  7. Tenesma

    Tenesma Senior Member
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    gorback be careful with early discharges w/ fent and versed... i had 2 episodes of patients passing out in the parking garage completely sedated!!!

    in Q&A review it seems like a possible explanation that not all the dose got to the patient upon administration, and that somebody flushed the IV before pulling it and the rest of the meds got in right before IV got yanked and patient got sent home...

    plus the other issue with sedation is the crazy goof ball patient who brings his 96 year old mother as the "escort" (she can't drive) and then unbeknownst to us (and despite signing paperwork confirming that he can't drive for 6 hours after the procedure), drives and gets in a wreck - get a DWI, and then sues the hospital/pain dept for not reinforcing the no-driving policy...
     
  8. lobelsteve

    lobelsteve SDN Lifetime Donor
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    The no driving thing is a big deal. It would not be a bad idea to hire on a medical transport company for patients who get sedation and their driver is MIA or is incapable. The patient gets stuck with the bill, but it is better than getting stuck with a DUI or worse- killing somebody while sedated and driving.
     
  9. Mister Mxyzptlk

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    We had patients who said they had a ride but that we caught driving themselves home. We now require the driver to show up with the patient and they sign a "Responsibility for Safe Transport" form stating that they understand that the patient will be impaired and they are driving the patient home.

    The patient also signs a section of the form acknowledging that they will be impaired and will not drive, and that should they incur any liability as a result of not following medical advice they agree to hold harmless my practice, myself, and my staff against any claims.
     
  10. C Fiber

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    How about PO/Im Ativan 15-30 min prior to procedure? I had my eyes Lasik'd with 0.5mg of Ativan. being that said, I cannot imagine my chronic pain patients agreeing to po ativan for a simple MBB. Nonetheless I have given patients IM Ativan/valium for shoulder dislocation reductions in baseball players, contruction guys......amazing.
     
  11. lobelsteve

    lobelsteve SDN Lifetime Donor
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    I was too chicken to try a BZD for Lasik. I took 5mg Ambien and thought I wasn't going to make it. I'm a lightweight.
     
  12. Mister Mxyzptlk

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    Gosh, I hope none of you guys ever have to go to the pain docs here on this board who think no one ever needs sedation. I guess they don't see patients like you (or me).
     

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