Differential block - what?

[Papa Lou]

I'm being asked to do a differential block. The patient has had no improvement several months postop after a few different injections. It's L2/3 and L4/5. I searched on the forums and saw this has been discussed in Waldman in the past. I'm not sure I want to carry on with the procedure as it may be futile. But would someone please tell me how to even perform it?

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[ampaphb]

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[101N]

People here feel that the concept is flawed due to uncontrolled extravasation with even
small volumes. If you have a Stimuplex you could do a comparative anesthetic only block
sequentially with a pain and paresthesia diary. But, this technique hasn't been validated.

 

[ampaphb]

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[SSdoc33]

Uncontrolled extravasation into the adjacent musculature has no impact on the pharmacokinetics of lidocaine and marcaine.

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he is talking about uncontrolled extravasation to the next level. IE: lack of specificity. Furman's stuff. i think

 

[lobelsteve]

Just stick a 25g into the L2 then the L4 root. Whichever one hurts mpre concordantly with usual pain is the right level.

 

[Aether2000]

The old way was to use procaine intrathecal in increasing concentration injections to select out sympathetics then sensory then motor...

 

[drpainfree]

differential block is time-consuming to do...if done properly, it differentiates somatic, sympathetic and psychogenic pain.