Thoracic epidural technique

[GottaHaveIt]

Hiw are you guys performing this?

I've learned it the way it is described in the Furman atlas, the "low in the hole" technique.

I had some attendings who would do it the same as a lumbar TFESI, walking it off the bone until it is under the chin of the Scottie Dog.

Is one superior or safer than the other?


Also what are you injecting? Just 10mg of dex or some cocktail?

---

Members don't see this ad.

 

[Dr. Ice]

Hiw are you guys performing this?

I've learned it the way it is described in the Furman atlas, the "low in the hole" technique.

I had some attendings who would do it the same as a lumbar TFESI, walking it off the bone until it is under the chin of the Scottie Dog.

Is one superior or safer than the other?


Also what are you injecting? Just 10mg of dex or some cocktail?

Why bother, many private insurances have squashed all thoracic interventions..pretty tough to even get a thoracic MRI these days

 

[bedrock]

Why bother, many private insurances have squashed all thoracic interventions..pretty tough to even get a thoracic MRI these days

depends on the area. I can do thoracic TFESI, no problem with my insurances. I don't do it very often, but likely 4-5X a year.

I personally use the low in the hole furman technique but I've never had a chance to see other versions. So I too would love to hear how our forum members do it.

 

[Gnarvin]

I am assuming you are talking about thoracic transforaminal ESI.

 

[soccrwz]

I do them for rib fractures after falls, which can be very painful and PHN, which help with splinting. Easier than IL ESI in thoracic due to angle

 

[GottaHaveIt]

I am assuming you are talking about thoracic transforaminal ESI.

Yep TFESI

 

[deleted875186]

I do ILESI, caudal tilt, hit inferior lamina and walk off. If we can place it blind for surgeries we should be able to place it with a smaller gauge needle and fluoro.

 

[Ferrismonk]

I do Thoracic TFESI, but I hate each one. I do similar to Lumbar TFESI, but try to hug closer to spine and am very careful on lateral.

 

[lobelsteve]

I do ILESI, caudal tilt, hit inferior lamina and walk off. If we can place it blind for surgeries we should be able to place it with a smaller gauge needle and fluoro.

Yes. I use 25G Quincke for this.

 

[epidural man]

I do ILESI, caudal tilt, hit inferior lamina and walk off. If we can place it blind for surgeries we should be able to place it with a smaller gauge needle and fluoro.

You would think, but even with fluoro, I have a abandoned a couple because I couldn’t enter (or went a lot lower).

 

[RoloTomassi]

I think ILESI is much easier. I more often than not don't get pretty dye flow on thoracic TFESI, not sure why, tried both supra and infraneural. With ILESI, I do 2 pillows under the chest, caudal tilt, start inferolateral to spinous process of the vertebrae below, to be in same angle as lamina and just walk along and off. CLO confirms the lamina angle you need.

 

[deleted875186]

I think ILESI is much easier. I more often than not don't get pretty dye flow on thoracic TFESI, not sure why, tried both supra and infraneural. With ILESI, I do 2 pillows under the chest, caudal tilt, start inferolateral to spinous process of the vertebrae below, to be in same angle as lamina and just walk along and off. CLO confirms the lamina angle you need.

I agree, CLO shows crisp lamina and is the view that makes it easiest. If I have trouble I just shallow out and go a level above in CLO.

 

[Laryngospasm]

If you haven’t failed at thoracic esi you haven’t done enough lol. I’ve had patients whose spines have basically turned to stone and you would need a drill to place one..

 

[soccrwz]

thoracic ESi intralaminar can be very challenging; thoracic TFESI much easier

 

[ziggyziggy]

I do them for rib fractures after falls, which can be very painful and PHN, which help with splinting. Easier than IL ESI in thoracic due to angle

Do you get better or longer relief than icnb? I can use depo in rib but not for TFESI.

 

[clubdeac]

thoracic ESi intralaminar can be very challenging; thoracic TFESI much easier

you're right! Going THROUGH the lamina can be very challenging I prefer to go between