High risk procedures?

[NOSfan]

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Which international pain procedures would you consider 'high risk'?

 

[101N]

C2 selective, C1/2 facet, CTFESI...

 

[epidural man]

Interlaminar cervical ESI's still scare me every time.

SGB's

Although I don't do them in Pain, in regional, lumbar plexus blocks (I hate doing these).

 

[Ducttape]

any injection done by a spine surgeon...

jk.

imo, celiacs in patients who were anticoagulated (until yesterday), hypogastric plexus blocks.

i will not do gasserian ganglion blocks.

 

[oreosandsake]

can i ask why you hate lumbar plexus blocks?

do you do SGBs under fluoro or US?

thanks

 

[Ligament]

Adenolysis of the pituitary surely must be the king!

Followed by trans-oral C2 vertebroplasty

Then V1 gasserian RFA

anterior C1-2 RFA

Hypoglossal nerve RFA at the styloid process

IT pump refills

IT opioid and LA trials

IT pump programming

Subrachnoid EtOH injection

RF Cordotomy

Cervical ILESI still scare me though I do them routinely. Contralateral oblique view has helped a lot.

CTFESI scare me more every year.

Granted many of the above are more NSX procedures but apparently some pain docs perform them. Other than those, I don't think we have any high risk procedures...???

 

[bedrock]

Good list by lig. I don't do anything on that list other than CESI, and I make patients fail a lot of conservative care before I will consider a CESI (at least a month of PT, NSAIDS, neuropathic meds, and a round of oral steroids before I will offer a CESI)

Once I figured out how little I got paid to do C1-C2 injections, I stopped doing those due to the combination of higher risk and minimal reimbursement. I send those to the local university now.

That's the interesting thing about ligaments list. None of those procedures pay remotely what they should for the risk, and I'm not going to legally expose myself for pennies.

The only one you can't really avoid is CESI. You can't not perform CESI and call yourself a pain physician, and get referrals if you don't offer one of the main procedures for the c-spine.

 

[Birdstrike]

Error

 

[Ducttape]

i did forget the alcohol based injections. celiacs, paravertebrals, ganglion impars blocks...
some of those on Ligs list i dont do, and wouldnt ever do.

SGB i dont hate as much now that i do them under US (with a little help with fluoro)

 

[emd123]

Good list by lig. I don't do anything on that list other than CESI, and I make patients fail a lot of conservative care before I will consider a CESI (at least a month of PT, NSAIDS, neuropathic meds, and a round of oral steroids before I will offer a CESI)

Once I figured out how little I got paid to do C1-C2 injections, I stopped doing those due to the combination of higher risk and minimal reimbursement. I send those to the local university now.

That's the interesting thing about ligaments list. None of those procedures pay remotely what they should for the risk, and I'm not going to legally expose myself for pennies.

The only one you can't really avoid is CESI. You can't not perform CESI and call yourself a pain physician, and get referrals if you don't offer one of the main procedures for the c-spine.

Same. I do none of those on his list but CESI (with CLO) also. I've done the hero thing. At this point, I'm okay with passing that baton and letting someone else be the hero.

 

[Ducttape]

To put it all in perspective, however, none of these procedures may be as risky as starting a patient on COT...

 

[epidural man]

To put it all in perspective, however, none of these procedures may be as risky as starting a patient on COT...

Holy crap this is soooo true. NNH is way higher for opioids than ANYTHING we do interventionlly. Also, higher cost to the insurers, higher cost to society as well.

 

[epidural man]

Adenolysis of the pituitary surely must be the king!

Followed by trans-oral C2 vertebroplasty

Then V1 gasserian RFA

anterior C1-2 RFA

Hypoglossal nerve RFA at the styloid process

IT pump refills

IT opioid and LA trials

IT pump programming

Subrachnoid EtOH injection

RF Cordotomy

Cervical ILESI still scare me though I do them routinely. Contralateral oblique view has helped a lot.

CTFESI scare me more every year.

Granted many of the above are more NSX procedures but apparently some pain docs perform them. Other than those, I don't think we have any high risk procedures...???

What is even more scary than CESI? Standing there watching a fellow do the CESI. To quote an attending at our place..."every time I watch a resident do an epidural, a part of me dies"

Also, ditto on the pump refills. We don't have pump patients anymore thank goodness.

Also it is true, I get scared every time I put ETOH or phenol anywhere.

 

[epidural man]

can i ask why you hate lumbar plexus blocks?

do you do SGBs under fluoro or US?

thanks

Used to do SGB under US then fluoro - now just use ultrasound. It certainly feels less risky - but still....lots of real estate in that area.

I hate lumbar plexus blocks because I have had a ton of bad stuff happen after them - including a high spinal/epidural. I don't know what it is about that block - it is a set up for badness. Plus, the juice isn't worth the squeeze.

 

[nvrsumr]

Cervical discos. Get roped into a couple a year

 

[Ligament]

Cervical discos. Get roped into a couple a year

That's such a rare beast in my woods.

 

[ampaphb]

Cervical discos, C/S TF-ESIs, C0/1 &/or C1/2 facets, C/S SCS trials &/or perms