Kenalog concerns

[bedrock]

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numbers game.

The artery of Adam can be as low as L5/s1. As a result at this level and above I will use Dex if I do a TFESI.

If I'm at s1 and will be doing a tFESI, teh chances of the artery adam being there is minimaly, so I'm more comfortable using some kenalog TFESI there.

In terms of ILESI. I use depot, because I thought it lasts longer and there is no FDA label against epidural use.

I understand your perspective on the A of A and when you use dex.

But if you're worried about the FDA label, why not use depo for all ILESI and the S1 TF? If you don't care, why not use kenalog for both ILESI and the S1 TFESI?
ILESI or TFESI are both epidurals from an FDA standpoint.

 

[PinchandBurn]

I understand your perspective on the A of A and when you use dex.

But if you're worried about the FDA label, why not use depo for all ILESI and the S1 TF? If you don't care, why not use kenalog for both ILESI and the S1 TFESI?
ILESI or TFESI are both epidurals from an FDA standpoint.

Gotcha, I see what you are saying now.

Yes, I did go back and forth in my head about this. I agree Kenalog is technically off label for epidural use. Again, I only use it for s1. The way I look at it, IF for the <1% chance at S1 I'm in a vascular structure OR if there's an abberrant A of A, atleast kenalog has less particulates.......

In fellowship, we routinely used depomedrol for TFESI. I know several 'big wigs' that still use depomedrol for TFESI. To be honest sometimes if I see no vascular uptk at all with LIVE fluro, then I do inject depomedrol. It's a battle, your damned either way.

 

[APDoc]

Just curious-- what dose of dexamethasone are you using for TFESI's since you are seeing similar efficacy?

Thanks.

 

[emd123]

Okay. I decided on Dex for TFs and Celestone all interlaminar epi's and kenalog for joints.

We'll see how it goes.....

 

[bedrock]

Okay. I decided on Dex for TFs and Celestone all interlaminar epi's and kenalog for joints.

We'll see how it goes.....

why did you decide on celestone for interlaminars?

 

[PinchandBurn]

Okay. I decided on Dex for TFs and Celestone all interlaminar epi's and kenalog for joints.

We'll see how it goes.....

yah why Celestone for ILESI? Depomedrol works just as well and is more readily available, and I thought it was cheaper....

 

[emd123]

I suppose the only thing I've definitely decided on is not to use Kenalog epidural since the FDA black box is "lawyer bait" and I don't want to bait lawyers my first month out of fellowship, plus there's enough confusion and guessing on this subject amongst experts that it's basically operator preference. I've stocked all these meds, so I may mix it up a little bit. I do like the idea do Dex for TFs, though. I don't like the thought of infarcting the cord even if it's 1 in 200,000. I don't know, "new attending nerves" I guess.

 

[myrandom2003]

Does anyone use Aristospan?
It is another triamcinolone preparation without the not for epidural warning.