Sedation for MB RF

[Orin]

IV sedation helps patients with fellows doing RFAs with 18g cannulas. Almost every RFA gets some sedation.

MBBs I can generally get them to avoid sedation, but the amount of needle movements and lack of hand holding by the ancillary team makes sedation easier in some of these patients. If they need sedation, I try to use just Versed at 0.5 - 1 mg IV.

I've done it MAC/GA but that's the 1-2% in an academic center where I'm in the hospital because of weight/AICD/LVAD/etc and the anesthesia team gets aggressive/protective

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[BobBarker]

I give oral diazepam 10mg for a pretty large percentage of my cervical rfa’s, very few of the lumbar get anything.

I have had to get about 1000% nicer in private practice. I am so kind and smooth talking them through procedures, I am exhausted from all of theatrics at the end of the day. But I don’t want them to get off the table and leave. 😂

 

[lobelsteve]

Steve with all due respect 90% of my patients have no clue who Jimmy Buffett is. Your technique works for your patients. It won’t work for my neck of the woods or my patient population. And that’s ok. It’s an art

So ignore the guidelines. At your peril.

 

[MitchLevi]

The more medical you make these injxns the worse of a time you’re gonna have with pts. Giving them IVs and making them fast overnight is insane.

 

[paindoc007]

Can you elaborate on dose and timing?

Yep, 5 or 10mg 30 min prior. Works great. Been using it for about 8 years now

 

[hopefulgasman]

Just so we're on the same page, this discussion is regarding oral/IV vs. no sedation for RFA, not for MBB.

No one here actually gives any form of sedation or knows someone who gives sedation for MBB I hope.

 

[DOctorJay]

The more medical you make these injxns the worse of a time you’re gonna have with pts. Giving them IVs and making them fast overnight is insane.

I remind lots of patients they don't get sedation for a flu shot or other vaccines

 

[NJPAIN]

Just so we're on the same page, this discussion is regarding oral/IV vs. no sedation for RFA, not for MBB.

No one here actually gives any form of sedation or knows someone who gives sedation for MBB I hope.

Yes. RF only

 

[jsaul]

There are many fellowship trained board certified docs still doing iv sedation for rf around here. All of them that do it this way

 

[GatorCHOMPions]

Just so we're on the same page, this discussion is regarding oral/IV vs. no sedation for RFA, not for MBB.

No one here actually gives any form of sedation or knows someone who gives sedation for MBB I hope.

Local OON practice gives IV sedation for almost everything in their ASC including MBB's.

 

[Scottie_Dog]

Local OON practice gives IV sedation for almost everything in their ASC including MBB's.

That is crazy. Probably hurts more to give IV than to do MBB with local. Most patients can tolerate 25 gauge needles without any local at the skin. IV sedation for MBB invalidates the diagnostic test in my mind. They probably sleep the rest of the day and report 100% relief. Leads to a lot of false positives.

I don't see an issue with offering PO/IV sedation with RFA. Beating a dead horse on this one.

 

[pmrmd]

That is crazy. Probably hurts more to give IV than to do MBB with local. Most patients can tolerate 25 gauge needles without any local at the skin. IV sedation for MBB invalidates the diagnostic test in my mind. They probably sleep the rest of the day and report 100% relief. Leads to a lot of false positives.

I don't see an issue with offering PO/IV sedation with RFA. Beating a dead horse on this one.

I’be heard of people using propofol for the procedure so there was no lingering effects of the sedative. Yep, crazy.