No local for MBB?

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Jan 21, 2016
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I'm the patient, 10 month post C6-C7 ACDF. Diagnosed with post surgical cervical radiculopathy, confirmed C7 impingement via EMG. 8 Weeks failed PT, no opiates, persistent scapular and radiating arm pain.

No SNRB, no facet injections, straight to MBB at C5, C6, C7. No sedation, no local (Lidocaine) administered, straight to fluoroscope guided needle. After dye and proper placement, I assume Bupivicaine was injected followed by unknown steroid, probably Kenalog.

The MBB procedure caused extreme discomfort, predominantly during re-positioning. I have an extremely high tolerance for pain, this was brutal. AP stated the excessive discomfort/pain reaction was probably due to excessive inflammation although my particular reaction was not typical. Pain relief was offered post procedure along with a genuine apology for the discomfort, I accepted the apology, offered my own for the moaning/groaning and squirming, didn't accept any meds.

My question is this. Why did he not administer a local? Upon the first insertion at C5 I notified him immediately that although it was tolerable I was extremely uncomfortable, this was prior to re-positioning and C6 C7 placement. Still, no local was injected, it was a white knuckle ride, bare back, no lube. I was told by his nurse after he had left that he didn't like use a local in some situations because he obtains more accurate DX without it.

I thought lidocaine was beneficial in DX? Why the steroid for a DX MBB, isn't that redundant if an ablation is the obvious next step with a positive?
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