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MBB poll
Started by specepic
Almost always without skin/subq. Some really sensitive patients I will. I would guess this is less than 5%.
Previously I only used LA at the MBB site. Use a 25g 3.5.
Recently, I have had several patients complain of post-procedural needle pain that was making it difficult to differentiate how much relief they received. So I started to numb the tract on my way out which has helped. These are usually the more anxious patients.
Recently, I have had several patients complain of post-procedural needle pain that was making it difficult to differentiate how much relief they received. So I started to numb the tract on my way out which has helped. These are usually the more anxious patients.
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Local needle same gauge as injection needle. Only local if 22g.
Same. Other than my local needle is 27G
What's your usual Quinke gauge? I started at a practice that uses 22g for everyone.
I would agree with that. After a decade in practice don’t think I have had someone have a robust response to lumbar RFA after lots of trouble tolerating MBB with a 25 gauge.
Thin, reasonable patients - no superficial numbing. Bigger, anxious patients - yes.
Interesting comments for sure! Not as simple of a concept as the OP hoped for (or maybe so). Very patient dependent. Agree with others in that patients jumping a off the table from a LA pinprick is a pseudo-red flag.
Im assuming those not using any local do multiple needles at time?
Im assuming those not using any local do multiple needles at time?
I go back and forth. Numbing with a 22g is much faster sometimes.
When the patient squirms and muscle is doing what muscles do, that 25g is not easy to dock - it takes some finesse and time.
I think if speed is your most important goal, local with 22g is better.
When the patient squirms and muscle is doing what muscles do, that 25g is not easy to dock - it takes some finesse and time.
I think if speed is your most important goal, local with 22g is better.
22G. Barbaric.
Bounce back and forth - older person who is somewhat frail = 25 gauge, 50-70 year old guy who refuses/can't give up farming or anyone with psych Lido + 22 gauge for speed.
Sometimes the 25 gauge led to more squirming and patient complaints.
I do like 25 gauge without lido on skinny/average young people when doing TFESI and have used for ILESI with success.
Sometimes the 25 gauge led to more squirming and patient complaints.
I do like 25 gauge without lido on skinny/average young people when doing TFESI and have used for ILESI with success.
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D
deleted131481
I mix lido with sodium bicarb for numbing and use 22g.
Not the most cost-efficient, but I found it to be the best balance for my practice that often includes fellows and patients and staff used to doing IV sedation.
Not the most cost-efficient, but I found it to be the best balance for my practice that often includes fellows and patients and staff used to doing IV sedation.
Had an attending at my fellowship do 22g without lido. Surprised by how many patients could tolerate it. Still looked rough though.
If body habitus allows, 25g 3.5” without skin local. If patients have a hard time with it for round one, I’ll use skin and subq local for round 2. I see this most helpful for the neck, but that may relate to my technique. I put one needle in each side to the center target level (e.g C6 for a C5-7), inject, then reorient down to C7, then up to C5.
For bigger patients especiallly with lumbar, 22g 5” with skin local. Used to use 25g but it took much more time to steer them.
For bigger patients especiallly with lumbar, 22g 5” with skin local. Used to use 25g but it took much more time to steer them.
Many practices in my area sedate for everything, including MBBs, so it's tough to convince most pts to do anything without at least a touch of lido. So usually lido w/25g 3.5" unless 5" needed in which case lido+22g.
On thinner older folks with less robust musculature I'll use a 27g 3.5g w/o lido. Harder to steer but good challenge and patients do great.
On thinner older folks with less robust musculature I'll use a 27g 3.5g w/o lido. Harder to steer but good challenge and patients do great.
25g for everyone unless a 5" isn't long enough, at which point I do a 22g 7". I am looking into 23g longer needles.
The smaller the diameter of the needle, the easier the pt's experience, and word of mouth does what it does...Clean, easy procedures result in a 3m wait list.
The smaller the diameter of the needle, the easier the pt's experience, and word of mouth does what it does...Clean, easy procedures result in a 3m wait list.
Let me know if you find a 23G longer than 3.5. I’d definitely use them.
For 3.5 in (normal thickness)patients I use a 23G for everything except MBB and ILESI.
I use thin needles as often as possible. I don't like thin needles in the SIJ bc of the resistance and I am trying to protect my hands from OA. 22g in the SIJ.
So so far it seems like things are about 50-50
Looking back at my last few years of practice I feel like I was getting some false positives on medial branch blocks so I’m trying to move away from numbing the skin. I used to only do one set of medial branch blocks for everyone just cause I was trying to save appointments slots and safe patience time and money but with Medicare requiring two sets I’m thinking of doing one set with skin numbing and the other without and comparing the results
Looking back at my last few years of practice I feel like I was getting some false positives on medial branch blocks so I’m trying to move away from numbing the skin. I used to only do one set of medial branch blocks for everyone just cause I was trying to save appointments slots and safe patience time and money but with Medicare requiring two sets I’m thinking of doing one set with skin numbing and the other without and comparing the results
well, they dont make 25g 7 inch needles.
Do one side with, one without, and ask the patients which was worse. That’s how I’ve trialed changes to MBB technique.
Ill argue if it takes a 7” needle to perform an MBB, don’t.
D
deleted875186
This doesn’t work, I’ve tried several times and patients always think the first side is more painful than the second no matter what.
I didn’t have that problem. And I just switch off which one I do first.
my patient population may be a little more gravitationally challenged than yours...
i do have roughly 5 regulars who need 7 inch needles for diagnostic blocks and have had favorable outcomes with RFA (with the 15s). facet arthropathy can happen to anyone.
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New Adult Obesity Maps
Obesity remains high, varies, by state, and affects some groups more than others.
www.cdc.gov
I thought we in Georgia were heavier than that.
Obesity a risk factor for failed RF.
jeez... i thought NY was worse than most.....
I (like all of us) have had no shortage of successful ablations in obese pts. If you have axial LBP with facet dz, I'll surely try it.
