Epidurals are monkey procedures. Frankly, a lot of epidurals and similar injections administered by pain docs are probably fake (we'll call it placebo to be politically correct). Oh yeah, you really nailed that facet block 🙄. The gastroenterologist sees a business opportunity and is taking advantage of a broken system. I'm sure there are plenty of anesthesia groups doing the same. There are worse things in medicine that mortify me.
A CESI is not straight-forward. Can you intelligently discuss:
R/B of IL vs TF approach?
ASRA and other societies anti-coag guidelines for chronic pain procedures
R/B of DSA vs live flouro vs spot shots with contrast injection
Different iodine based contrast agents labeling for intrathecal vs non intrathecal as well as different degrees of radiopaqueness and appropriate agent selection
R/B of gadolinium based agents in people with iodine allergies
EBM prophylactic regimens for moderate contrast reactions with iodinated contrast agents
Anatomy of cervical segmental medullary arteries, vertebral arteries, and contrast patterns with venous versus arterial injection
Safe minimum amount of epidural space present on MRI and how to assess a given spinal level for safety
Amount of injectate to be used for maximum safety/efficacy
R/B of local/steroid versus steroid only
R/B of seated versus prone approach
CLO versus straight lateral to assess depth
Manipulation of fluoroscope to obtain true AP/true lateral images in altered spinal anatomy
Optimal degree of CLO for accurate needle placement
After which spine surgeries CESIs are safe versus unsafe at any given level
Difference between SNRB and TFESI?
Clinical utility of SNRB diagnostically and in guiding surgical approach
R/B of catheter versus through needle
R/B of midline approach versus paramedian in terms of discontinuous ligament in the midline
R/B of injection at levels superior to C7/T1 in terms of discontinuous ligament at superior levels
R/B Particulate versus non-particulate steroid
R/B of perservative free steroid formulations
Various types of systemic versus local chronic and/or acute infections ranging from HIV to various dental procedures and if CESI is safe in these senarios if on/not on antimicrobials
Indications for spine surgery referral based on history/physical/imaging rather than just doing the injection
Safe amount of CESIs to do in a given time period based on pt and risk factors present
Assessment of cervical instability, myelopathy, syrinx, cancer, hardware failure, shoulder pathology, myofascial pain, facetogenic pain, etc etc that needs to be excluded in assessing cervical radicular pain...including comprehensive physical examination, knowledge of indications for and sensitivity/specificity of EMG/NCV, MRI w/ contrast, MRI w/o contrast, CT, CT myelogram.
And so on.
No? Neither can any of the CRNAs doing CESIs. And neither can 99.999% of referring surgeons speak intelligently to all these issues. Seems to me this would be, off the top of my head,
the minimum type of knowledge one would need to safely perform these injections.
And note that his all only has to do with actually doing a CESI. Not managing someone with radicular pain. That is a much larger base of knowledge. Including a comprehensive knowledge of evidence for various types of PT, traction, TENs, neck braces, CESI versus SCS versus various surgical approaches to radicular pain, various pain medications topical and oral NNT, side effects, use in CKD/Liver disease, etc.
Etc, etc.
You get the point I hope. Because your post was pretty ignorant.
There is a reason pain fellowship is a year.
CRNAs should NOOOOOOOOOOOOOOOOTTTTTTTTTTTTTT be doing CESIs man.
How are we gonna win the "battle against CRNAs" with this type of commentary floating around from our own...
Get a clue.