Procedures Flashcards
This procedure is to treat extremity weakness and /or radicular pain, numbness and tingling
What’s the Acronym?
ESI (Epidural steroid injection)
What does “MBBs” stand for?
MEDIAL BRANCH BLOCKS
What are the most common types of ESI’s (in our practice)?
- TRANSFORAMINAL EPIDURAL STEROID INJECTIONs
2. ILESI
What are medial branch blocks used for?
- They are a short-lasting nerve block
- They act a diagnostic (test) injections to determine the whether Radiofrequency
Nerve Ablations would be the appropriate next step.
What is an FJI and what procedure is it similar to?
FJI= Facet Joint Injection. They are similar to MBBs although they have a small amount of steroid in them also.
Sometimes they are done instead of RFNs or ESI’s if insurance doesn’t cover an RFNs or ESI.
They help with axial pain and the steroid may help with radicular symtoms.
What is a “good result” after MBBs?
A good result insurance companies are usually looking for is at least 60% relief (from baseline pain) x 3-4 hours.
Most insurances do not require a recent MRI for which types of lumbar/cervical/thoracic spine injections?
ESIs, MBBs, FJIs
(Although it does depend on the person, whether they have hardware from surgery and if the are some types ofBCBS ins.
What does RFN or RFA mean?
RADIOFREQUENCY NERVE ABLATION
It is very important to monitor your pain every couple hours after which type of injection? Why? Should you take medicine after the procedure?
MBBs.
Why?
They are usually done as a diagnostic procedure and once everything wears off and their sedation clears up you may not remember even having a procedure!
No.
Wait until your pain goes back to baseline before taking any pain meds. This will help determine the outcome of the procedures.
True or false?
You do not have hold NSAIDs and blood thinners before a procedure?
FALSE.
FOR REGULAR NSAIDs and OTCs hold 3 days prior to Lumbar MBBs and 5-7 days prior to Lumbar RFNs.
Hold for 5-7 days for neck procedures.
Scenario:
A patient calls office stating they had “a nerve burn” this morning and now are in a lot of pain. They say it hurts to move certain ways and it feels like they were “sunburned” where they had injections.
How would you deal with this patient?
- Confirm procedure, take note of lumbar or cervical.
- Ask:
- are your injection sites tender to touch?
- Are they swollen and or red or bruised?
- Is there any fluid (exudate) from the injection site?
- Are you feeling and new weakness or new onset pain?
Assuming these are negative:
ASK: Have they taken their hydrocodone? If not then take it with some advil
ADVISE: If they don’t have that and their other meds are not contradicted they may take Tylenol and Ibuprofen at same time.
ADVISE: to apply a cool clothe or ice pack to site that this not uncommon and to INFORM office if they don’t feel better in a couple of days.
ASK: Lastly do they take gabapentin? If so they may double up the first night.
TELL: them they may call anytime we have an office cell.
A pt calls after having an RFN this morning.
What do you ask them?
- are your injection sites tender to touch? Yes a little
- Are they swollen and or red or bruised? Not really, a little swollen,
- Is there any fluid (exudate) from the injection site? No.
- Are you feeling any new weakness or new onset pain?
Yes! Now I have sharp pain down my leg:(
(Same as #4- make an appt for next f/u for next appt. .
- Offer next available appt, suggest NSAIDs, Gabapentin pain meds.
- Text Dr to inform, make pt case and leave open.
- Ice pack and take ibuprofen/hydrocodone one if available.
- Apply Ice pack and take ibuprofen/hydrocodone if available.
DO NOT USE HEAT.
- if it’s their neck explain it does cause bruising sometimes. - If there is any place on schedule set up OV
- Offer scheduling RTO, and inform dr. Pppp
When would and SI Joint injection be appropriate?
With point tenderness and main complaint
