I'm not sure we are understanding one another here.
First of all, I completely agree about the no selective comment. In fact, in my notes, I always document "targeted nerve block" rather than selective nerve block because of the fact you point out. However, with ultrasound, I am pretty sure I don't get epidural or central flow, and I can see the medicine flow around the nerve root in question. By the way, I mix contrast with the local so I can confirm with a fluoro shot after injection - and I have never seen epidural flow yet. I always get a great perinuerogram however.
I also AGREE that there is no data that US is better. However, I promise you, I can see much more than you can on fluoro - but maybe you think YOU have magic eyes with fluoro and DSA. (And the truth is, I can't think of a time I saw vascular uptake on DSA that I didn't already notice on live fluoro.) Has DSA sensitivity ever been proven (correlated to the size of vessel it can pick up?) I am unaware of any comparison to US - as far as which can pick up the smallest vessel.
By the way, I never claimed that (or if I did...I retract it) we should all be using ultrasound cuz it is so much safer. I do, however, find it strange that i mentioned I used that AND you came with guns ablazing with accusations why I SHOULDN'T be doing it. That to me is a little odd. Also considering the fact that you don't use a lot of ultrasound confirms that. I'm not saying you should use ultrasound, but holy crap - so what if some are.
For me, it makes a lot of sense for lots of things. If you have ever seen a piriformis under ultrasound - it just works so well and so reliable and satisfying. (I am always so dissappointed in my blobagrams). And that is my crutch - if I were better at fluoro, I probably would never get a blogagram. A genifofemoral injection and ilioinguinal, or lateral femoral cutaneous - all make so much sense with ultrasound.
And as I mentioned in another post, any time I can cut down on my fluoro time - its a good thing for me. I'm a little paranoid about that - maybe I don't need to be, but I am I.
Final point - I have no idea what most people do. It sounds like people are using ultrasound (for spinal procedures - like Dx MBB's) just to get more billing. I agree that this is fraud and horrible. I can't imagine using ultrasound for Dx MBB's or many of the things I do. I have tried using it for the suprascapular nerve, but it still makes no sense to me.
I will say that I love using it for my mid and upper back trigger points. I can see the muscle, the depth of the pleura, my needle, and the medicine spread. Now that may be overkill and it does take longer, but I get the trigger point right every time.