What are yall's med concoctions?

[FacetiousJoint]

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For Lumbar ILESI --> typically 80mg depo (40mg if diabetic) + 5cc saline + 2% bupi .25%
Cervical ILESI --> 1 dex 10mg + 5-6 cc NS.
We have an attending that likes to use depo for cervical ILESI although i am hesitant to use any particulate in the neck

Cervical MBB is dex + 0.3cc .25% bupi
Lumbar MBB is depo 80/40 + 1cc of .25% bupi

Caudals are usually depo 40/80 + 5cc saline + 2cc .25% bupi

TFESIs are 1cc dex + 1cc NS + 1cc .25% bupi, 1.5 cc for each level

What do yall use? Just curious

 

[bubaghanush]

For Lumbar ILESI --> typically 80mg depo (40mg if diabetic) + 5cc saline + 2% bupi .25%
Cervical ILESI --> 1 dex 10mg + 5-6 cc NS.
We have an attending that likes to use depo for cervical ILESI although i am hesitant to use any particulate in the neck

Cervical MBB is dex + 0.3cc .25% bupi
Lumbar MBB is depo 80/40 + 1cc of .25% bupi

Caudals are usually depo 40/80 + 5cc saline + 2cc .25% bupi

TFESIs are 1cc dex + 1cc NS + 1cc .25% bupi, 1.5 cc for each level

What do yall use? Just curious

ILESI: Depo 80mg + saline. Diabetic gets 40mg. Cervical is 4 cc total and lumbar 5cc total.

TFESI: 10mg dexamethasone+ 5cc saline. 3cc per level

MBB: 0.5cc bupiv per level

 

[Dr. Ice]

For Lumbar ILESI --> typically 80mg depo (40mg if diabetic) + 5cc saline + 2% bupi .25%
Cervical ILESI --> 1 dex 10mg + 5-6 cc NS.
We have an attending that likes to use depo for cervical ILESI although i am hesitant to use any particulate in the neck

Cervical MBB is dex + 0.3cc .25% bupi
Lumbar MBB is depo 80/40 + 1cc of .25% bupi

Caudals are usually depo 40/80 + 5cc saline + 2cc .25% bupi

TFESIs are 1cc dex + 1cc NS + 1cc .25% bupi, 1.5 cc for each level

What do yall use? Just curious

Don’t use steroid in mbb..it should really be fraudulent to do it, plus it’s gonna suck once the Rfa doesn’t work because you coated the area with steroids and got a false block

 

[pmrmd]

In what healthcare universe is Depomedrol used in an mbb?

 

[Laryngospasm]

For Lumbar ILESI --> typically 80mg depo (40mg if diabetic) + 5cc saline + 2% bupi .25%
Cervical ILESI --> 1 dex 10mg + 5-6 cc NS.
We have an attending that likes to use depo for cervical ILESI although i am hesitant to use any particulate in the neck

Cervical MBB is dex + 0.3cc .25% bupi
Lumbar MBB is depo 80/40 + 1cc of .25% bupi

Caudals are usually depo 40/80 + 5cc saline + 2cc .25% bupi

TFESIs are 1cc dex + 1cc NS + 1cc .25% bupi, 1.5 cc for each level

What do yall use? Just curious

Hope you’ve got your flame suit on.. lol..

 

[giddyup]

For Lumbar ILESI --> typically 80mg depo (40mg if diabetic) + 5cc saline + 2% bupi .25%
Cervical ILESI --> 1 dex 10mg + 5-6 cc NS.
We have an attending that likes to use depo for cervical ILESI although i am hesitant to use any particulate in the neck

Cervical MBB is dex + 0.3cc .25% bupi
Lumbar MBB is depo 80/40 + 1cc of .25% bupi

Caudals are usually depo 40/80 + 5cc saline + 2cc .25% bupi

TFESIs are 1cc dex + 1cc NS + 1cc .25% bupi, 1.5 cc for each level

What do yall use? Just curious

80 mg depo for cervical and lumbar interlam with 4cc saline

Mbb 0.5mL 0.75% bup

Lumbar TF 10mg dex 1mL 1% lido - cervical same but only 0.5 ml of the local

Joints 40mg Kenalog with 3ml 1% lido

 

[Ducttape]

ILESI: 80 depo +3 ml saline, cervical or lumbar or thoracic, 80 mg depo and 7-8 ml saline for caudal.
unless inpatient, in which case 1 ml 0.25% bupivacaine added

TFESI: 10 mg dex +1 ml saline all levels except S1.
unless inpatient, in which case 1 ml 0.25% bupivacaine used instead of saline.
TFESI S1: 10 mg dex + 3 ml saline

i dont do cervical TFESI.

cervical MBB: 0.3 ml 0.25% bupivacaine #1 then 1% lidocaine #2
lumbar MBB: 0.5 ml 0.25% bupivacaine then 1% lidocaine #2


if you use steroids for MBB, you may find that you have to wait 3+ months to get approval for RFA as some insurance companies require that the injection to be beneficial by 80% for the duration of the injectate. in other words, 3 months benefit from MBB.

 

[RaceCanyon]

ILESI 10 mg dex, 3-4 mL NS
ILESI (L4/5 or L5/S1 if dex fails) 40 mg depo, 3-4 mL NS
TFESI - same but no depo
CESI 10 mg dex 1-2 mL NS
CMBB/LMBB 0.5-0.75 mL 2% lido

 

[runfastnow]

C and L ILESI: 80 depo + 2cc saline + 1 cc contrast flush
C TFESI: 10 dex + 1 saline
L TFESI: 10 dex + 1cc lido 1% per level or 80 depo if chronic radic/stenosis and dex failed and L4-S1 level.
MBBs: 0.3cc 0.5% Bup; rarely use 0.3cc 1% lido in patients who are unreliable historians and have had success getting them to focus on just a few hours of pain relief vs 12+hours.
RFA will rarely place 80 depo spread across all levels if really whiny patient or patient has event/trip/etc. the first few days after RFA.

 

[DOctorJay]

C/L ILESI: 80 depo + 2cc/3cc saline
L TFESI: 10 dex + 0.5cc saline
MBBs: (#1) 0.5cc 2% lidocaine, (#2) - 0.5cc 0.5% Bup
RFA: 2% lidocaine only, no steroid

 

[JFS]

ILESI CTL 12 mg beta, 2 ml NS. Caudal 4 ml NS
TFESI C,T,L 10 mg dex, 0.5 ml 2% lido. 2 level - 10 mg dex + 1ml lido split in half
MBB C 0.3 ml 2% lido + 0.2 ml contrast per level, T/L 0.5 ml 2% lido only per level
RFA/Kypho/SCS/BVNA/Sprint 2% lido with epi

 

[SgtThunderfistMD]

For Lumbar ILESI --> typically 80mg depo (40mg if diabetic) + 5cc saline + 2% bupi .25%
Cervical ILESI --> 1 dex 10mg + 5-6 cc NS.
We have an attending that likes to use depo for cervical ILESI although i am hesitant to use any particulate in the neck

Cervical MBB is dex + 0.3cc .25% bupi
Lumbar MBB is depo 80/40 + 1cc of .25% bupi

Caudals are usually depo 40/80 + 5cc saline + 2cc .25% bupi

TFESIs are 1cc dex + 1cc NS + 1cc .25% bupi, 1.5 cc for each level

What do yall use? Just curious

2 cc depo + 5cc saline + 2cc of 0.25% bupi? so essentially, 7cc of 0.07% bupi. How does that make sense?
Also there is no risk of particulate in any IL approach.

 

[clubdeac]

2 cc depo + 5cc saline + 2cc of 0.25% bupi? so essentially, 7cc of 0.07% bupi. How does that make sense?
Also there is no risk of particulate in any IL approach.

Mostly true, there is potential risk of preservative resulting in arachnoiditis if inadvertent IT injection during ILESI. This is not a risk with “most” dexa preparations which are preservative free

 

[interjectionreflection]

Mostly true, there is potential risk of preservative resulting in arachnoiditis if inadvertent IT injection during ILESI. This is not a risk with “most” dexa preparations which are preservative free

Isn't that a risk with IT local as well?

 

[au bon pain]

Isn't that a risk with IT local as well?

I think there was maybe one case report that said this was maybe possible and it was from a labor epidural— so far from convincing. Meanwhile, there are multiple reports of depo causing this—not amazing level of evidence either, but seemingly more plausible.

You could also just use saline and dex (or depo) for your ESIs. Aside from having a bit less relief on day one, the folks do just as well as those who get local in their injectate.

 

[Scottie_Dog]

I decreased the dose of steroid from 80 to 40 for interlams, anecdotally haven’t noticed a difference.

 

[clubdeac]

Isn't that a risk with IT local as well?

If there’s preservatives. Not for PF obviously

 

[CleanUp]

I decreased the dose of steroid from 80 to 40 for interlams, anecdotally haven’t noticed a difference.

Same.

 

[BobBarker]

Yes. 40mg depo does great. No reason for 80mg.

 

[Ducttape]

just point of information - dex (PF) does have a preservative.

citric acid was previously labelled a food additive, so technically not a preservative, but it still is.

i know of no study that suggests that citric acid causes arachnoiditis.

 

[giddyup]

I decreased the dose of steroid from 80 to 40 for interlams, anecdotally haven’t noticed a difference.

opposite for me. I decreased and patient's noticed a difference and went back to 80

 

[Ferrismonk]

Lumbar ILESI --> Rarely do these. But 4mL 0.25% bupi or saline and 10 dex.
Caudal ESI --> 5mL 0.25% bupi or saline and 10 dex
Lumbar TFESI --> 2mL per location, Mixture of 10 dex and whatever mL 0.25% bupi or saline to get the right volume
Cervical ESI --> 4mL Saline, 10 dex
Cervical MBB --> 0.5% bupi
Lumbar MBB --> 0.5% bupi

Your attendings are practicing old school.

 

[clubdeac]

Lumbar ILESI --> Rarely do these. But 4mL 0.25% bupi or saline and 10 dex.
Caudal ESI --> 5mL 0.25% bupi or saline and 10 dex
Lumbar TFESI --> 2mL per location, Mixture of 10 dex and whatever mL 0.25% bupi or saline to get the right volume
Cervical ESI --> 4mL Saline, 10 dex
Cervical MBB --> 0.5% bupi
Lumbar MBB --> 0.5% bupi

Your attendings are practicing old school.

you're a dex guy for everything huh.... interesting. I have not seen good results with dex when switching to this in all of my TFESIs

 

[Ferrismonk]

I used to use Depo back in residency, switched to dex at fellowship. I use primarily dex and haven't noticed much difference to be honest. My partners often will use depo or kenalog, but our TFEs all work about the same.

Again, I'm doing mostly for radicular pain and don't do much interlaminar for SS.