Lateral Cervical MBB Flow

[agolden1]

Multiple cervical MBB threads discussing prone vs lateral and approach therein which I've seen over the years.

A few questions for those doing lateral approach balancing safety and efficiency.

Presently doing a one needle per level technique. So if doing C3-C5, will place one 25 Ga needle for each location without local at entry. AP shots down to bone. Once on bone, will do lateral for confirmation. Administer contrast at each location separately to confirm not intravascular then administer local at each site and out. Use three needles as compared to one entry site so I can see all on the lateral at one time and not have to have my tech keep swinging back and forth for each spot as I would with a one needle technique. This seemed like the safest option as I could confirm depth and confirm not intra-vascular before injecting, but was uncertain if I was just creating more work for myself.

What are other people doing for these? One needle vs three needle? Contrast? Do you even bother with a lateral?

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[BobBarker]

I have done it a few different ways. I had an attending that would use the tiny local needle and just move it from spot to spot on thin necks. I have done it that way and the way you describe.


I prefer prone as you do not have to move the patient and you are able to see how difficult the RFA would be.

 

[au bon pain]

Used to do them lateral but went back to plain old prone. Not only is it safer and can give sneak preview of RFA as Bob said, but it gives me an idea of how well the patient can tolerate the positioning for the RFA (I don’t sedated).
I don’t use contrast.

 

[bedrock]

Used to do them lateral but went back to plain old prone. Not only is it safer and can give sneak preview of RFA as Bob said, but it gives me an idea of how well the patient can tolerate the positioning for the RFA (I don’t sedated).
I don’t use contrast.

Contrast spread reveals a lot with lateral cervical MBB. There are times that I’m perfectly center mass and it doesn’t spread anything like I expect.

 

[agolden1]

Contrast spread reveals a lot with lateral cervical MBB. There are times that I’m perfectly center mass and it doesn’t spread anything like I expect.

I’ve noticed this too. Often seemed to be solved by walking just slightly anterior from center.

I’ve considered just doing posterior approaches, but unilateral laterals do seem fairly efficient with a good X-ray tech.

 

[GlowInTheDark]

I will do lateral approach in supine position for skinny and/or long necks. Rarely if I’m doing C6-7 or don’t think I will be able to get shoulders out of the way for C6 will I do posterior.

 

[Espn123]

Prone, lateral entry, lateral view, redirecting a short 25g spinal

 

[Baron Samedi]

Prone, lateral entry, lateral view, redirecting a short 25g spinal

Any particular reason you don't have the pt side-lying?

Prone sounds like ergonomically more challenging and more radiation to you.

 

[SSdoc33]

do yourself a favor and do them all prone

safer and quicker

 

[SC Tian]

do cervical mbb using 25 1.5 inch ndl with patients over 300 lbs with no issues, need to change position for bilateral blocks.

 

[bedrock]

do cervical mbb using 25 1.5 inch ndl with patients over 300 lbs with no issues, need to change position for bilateral blocks.

Hard to do MBB on a 300lb patient with only a 1.5 in length needle. Maybe C2, C3.

 

[SC Tian]

Hard to do MBB on a 300lb patient with only a 1.5 in length needle. Maybe C2, C3.

You are right! Sorry, it is my mistake, 2.5 in ndl indeed, in the past 10 years, no exceptions. Imo, you have to go through layers of paraspinal muscles using posterior approach, this may or may not affect the accuracy of mbb.