Multimodal cocktail

[callmeanesthesia]

Advertisement - Members don't see this ad

Have any of you tried a multimodal cocktail preoperatively for RF or other potentially painful procedures? I’m thinking of giving patients a preprocedure dose of lyrica, NSAID, and Tylenol, and maybe a lidocaine patch to put on that night. I know there’s decent evidence for preop oral medications in the surgical literature. I feel like I hear “I hated you for the first week but now it’s great!” a lot.
On the other hand, just found this on PubMed saying steroids and antineuropathics don’t seem to help The Impact of Local Steroid Administration on the Incidence of Neuritis following Lumbar Facet Radiofrequency Neurotomy. - PubMed - NCBI

 

[paindoc007]

I find that really interesting. I’m a huge fan of RFA, where I get some of my best results from all the procedures I do. I prob do 8-10 rfa cases weekly. And honestly I almost never hear the “the first week was miserable” or “I hated you for a while post op”

We always give a post op instruction sheet for the first 24-48 hours like to ice, take anti inflammatory, etc. I’m curious others’ experience with post op pain from RFA.

 

[SommeRiver]

In the neck I see it occasionally but usually not in the back after I shortened the duration of my lesion from 3 min to 2 min.

 

[callmeanesthesia]

I find that really interesting. I’m a huge fan of RFA, where I get some of my best results from all the procedures I do. I prob do 8-10 rfa cases weekly. And honestly I almost never hear the “the first week was miserable” or “I hated you for a while post op”

We always give a post op instruction sheet for the first 24-48 hours like to ice, take anti inflammatory, etc. I’m curious others’ experience with post op pain from RFA.

Ok, so it’s not that frequent but at least some post-procedure pain is very common if you ask. Seems worse with neck and knee. For the 2 patients recently who did say something like that they hated me for a while after, it may also have been put in contrast to the almost total relief of their pain after that. (And don’t get me wrong, RF and MBBs are probably over 1/2 of my business so I do a lot and love it - I’m just looking for ways to refine the experience).

 

[lobelsteve]

Ok, so it’s not that frequent but at least some post-procedure pain is very common if you ask. Seems worse with neck and knee. For the 2 patients recently who did say something like that they hated me for a while after, it may also have been put in contrast to the almost total relief of their pain after that. (And don’t get me wrong, RF and MBBs are probably over 1/2 of my business so I do a lot and love it - I’m just looking for ways to refine the experience).

Play better music, offer coffee post procedure, have a good conversation during the procedure.

 

[Taus]

Ice, ice and more ice for a few days on c spine and knee rf. Very rarely hear about severe pain. Pretty much only the young, slender whiplash patients with active auto cases on c rfa. I’ll send em in a medrol dosepack

 

[callmeanesthesia]

Play better music, offer coffee post procedure, have a good conversation during the procedure.

I play classic rock. My boomer patients love it. Coffee post-procedure is a great idea