GIGO Study, MBB

[pastafan]

Love it. MBB local skin wheal pain study. Obese patients excluded, not applicable to my practice.

Procedural Pain During Lumbar Medial Branch Blocks With and Without Skin Wheal Anesthesia: A Prospective Comparative Observational Study

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[callmeanesthesia]

Should be even more difference in obese patients because the local numbs proportionally even less of the needle tract. I don’t do local for 25g sticks. For most patients it really is less painful without, and it saves time, and there’s no need to mark the skin. Also for MBBs there’s a little less trigger point injection type placebo effect.

 

[hyperalgesia]

I use a 30g for all my skin wheals. I think it helps.

 

[Ducttape]

Study implies that local anesthetic may not effect results of MBB... would like to see them parse the data and analyze whether there was an effect on positive/negative rates of the provedure...

 

[pastafan]

Skin wheals hurt. Just use a 27g or smaller needle and inject straight down in skin w/o raising a wheal. Appears to be less painful than MBB w/o it in my patients.

 

[SSdoc33]

Just needle down to the medial branch. In, out, done. If patients cant tolerate the procedure, then you dont want to RF anyway

 

[Tapspatellas]

I have been saying this for years. I can’t say I see a difference in 27g, 25g or skin wheal. I think that some patients have a better “experience” with the procedure when they separate the actual procedure from the numbing itself, even if the local hurts more. When I tell them “that was just the numbing and the rest shouldn’t be too uncomfortable” anecdotally I find they don’t think the procedure was too bad. Many times I’ve numbed one side and not the other and it seems truly chance which the patient tells me was more uncomfortable, close to 50-50. I’ll say that I generally don’t do a wheal for smaller than 22G

I think the method of a local infiltration matters too. Going straight down perpendicular, injecting on the withdrawal and creating a very small and quick wheal in the skin is the least painful. It is much more painful in my opinion to do a parallel insertion of the needle subdermally and/or do a very large skin wheal, that’s where the highest concentration of pain receptors are located for the region that is being anesthetized.

 

[pastafan]

I think the method of a local infiltration matters too. Going straight down perpendicular, injecting on the withdrawal and creating a very small and quick wheal in the skin is the least painful. It is much more painful in my opinion to do a parallel insertion of the needle subdermally and/or do a very large skin wheal, that’s where the highest concentration of pain receptors are located for the region that is being anesthetized.

Definitely agree.