SpinALL

2+ Year Member
Jan 22, 2016
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Resident [Any Field]
Are there any guidelines/studies with evidence for using a set of 3 nerve blocks on *insert your favorite nerve* before advancing treatment to RFA or the whatever the next appropriate step is? Would be interested in evidence for this in any scenario.

For example, if a patient gets an anesthetic/steroid block and gets 2 weeks of 100% relief... what is the logic for not immediately going to RFA vs performing 3 nerve blocks. From an outsider perspective I'm sure there could be some financial incentive... but is there a proven benefit to stacking injections where they get more and more effective?

Even if its not well studied, etc, would be interested in hearing what your experiences have been.

Thanks!
 

Orin

10+ Year Member
Jul 27, 2009
806
316
Status
Are there any guidelines/studies with evidence for using a set of 3 nerve blocks on *insert your favorite nerve* before advancing treatment to RFA or the whatever the next appropriate step is?
Insurance wise, I think 2 before burn is usual, though some are okay with 1 it seems.

Reasonably, I prefer to measure twice and cut once. Ideally with low volume perineural local only in one to reduce the possibility of a false positive before ablating.

With some peripheral stim cases, I'm blocking once prior to implanting the peripheral stimulator.
 
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Tapspatellas

10+ Year Member
Oct 12, 2009
293
66
Status
Attending Physician
Are there any guidelines/studies with evidence for using a set of 3 nerve blocks on *insert your favorite nerve* before advancing treatment to RFA or the whatever the next appropriate step is? Would be interested in evidence for this in any scenario.

For example, if a patient gets an anesthetic/steroid block and gets 2 weeks of 100% relief... what is the logic for not immediately going to RFA vs performing 3 nerve blocks. From an outsider perspective I'm sure there could be some financial incentive... but is there a proven benefit to stacking injections where they get more and more effective?

Even if its not well studied, etc, would be interested in hearing what your experiences have been.

Thanks!
It is all about improving diagnostic certainty, trying to avoid unnecessary RFA. The higher the pre-test probability, the higher the likelihood after 1, 2, 3, etc blocks that you are dealing with the presumed diagnosis and not false positive response to blocks. The gold standard studies use dual medial branch blocks with low volume anesthetic as the criterion to proceed with RFA, not the garbage the Dutch are putting out mind you. If I obtain 100% relief with dual MBB in a 65yo with non-radicular back pain, fairly high certainty that I am dealing with facet arthropathy. Compare to a 30yo and that is much lower since the prevalence is much lower. standard is dual blocks, haven't heard of any routinely doing 3, but can think a couple circumstances I would consider. Much different than a series of 3 epidural injections mind you.
 
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