Interventional Procedures in Chronic Pain Management

Interventional Procedures in Chronic Pain Management Muhammad A. Munir, MD Diplomat American Board of Anesthesiology and Pain Management Fluoroscopy...
Author: Giles Butler
3 downloads 0 Views 9MB Size
Interventional Procedures in Chronic Pain Management Muhammad A. Munir, MD Diplomat American Board of Anesthesiology and Pain Management

Fluoroscopy • Two types of x-ray procedures – Conventional radiography – C-arm fluoroscopy

• Fixed X-ray tube vs mobile X-ray • Image intensifier

Parallax Error • Parallax error is the most common error. • The x-ray beam should be perpendicular in all planes to the desired target for performing a procedure. • If the desired target is off axis, the parallax error occurs and will create a phantom target, resulting in incorrect needle placement.

Radiation And Contrast Material Safety • WHAT IS A RAD AND IS IT BAD? – A rad (radiation absorbed dose) is an older and now obsolete unit for the measure of deposited energy in tissue from ionizing radiation – The newer unit is the Gray (Gy). One Gy is equal to 100 rads (1 Gy=100 rads)

• The rem (radiation equivalent man) and the Sievert (Sv), are used to express the quantity of radiation received by radiation workers. • One Sv is equal to one Gy which equals 100 rem (1 Sv=1 Gy=100 rem). • Finally, one Roentgen is equal to one rad, which is equal to one rem (1 R=1 rem=1 rad).

How much Rad is Bad? • •

The FDA policy states "no occupational exposed person may receive an effective whole-body dose of more than 50 mGy (5 rads) per calendar year as a result of incidental exposure to radiation in the workplace". The U.S. Nuclear Regulatory Commission has established four adult occupational dose limits, three of which are relevant to interventional pain management practice are as follows: – 5 rads for the total effective dose equivalent (TEDE), which is the sum of the deep dose equivalent (DDE) from external exposure to the whole body and the committed effective dose equivalent (CEDE) from intakes of radioactive material. – 15 rads for the lens dose equivalent (LDE), which is the external dose to the lens of the eye. – 50 rads for the shallow dose equivalent (SDE), which is external dose to the skin or to any extremity.

• In simple terms, 5 rads is equivalent to four minutes of fluoroscopic exposure a day without a lead apron.

Interventional Procedure Tips • If at first you don’t succeed, blame it on your attending. • If at first you don’t succeed, try to hide your astonishment • If at first you don’t succeed, destroy all evidence that you tried. • If at first you don’t succeed, redefine success. • If at first you don’t succeed, you will get a lot of free advice from folks who didn’t succeed either.

Glossopharyngeal Nerve Block

Glossopharyngeal Nerve Block

Left Cervical Neural Foramina

Cervical Nerve Root Block

Cervical Nerve Root Block

Cervical Medial branch block

Cervical Medial Branch Block

C-2 DRG/Selective Nerve Root Block

Cervical Discography

Stellate Ganglion Block

Murphy’s Laws • If any thing can go wrong, it will • If there is a possibility of several things going wrong, the one that will cause the most damage will be the one to go wrong. • If anything cannot go wrong, it will anyway • Left to themselves, things tend to go from bad to worse.

Lumbar Imaging

Lumbar “true” AP

Lumbar “true” Lateral

Scotty Dog

TF-ESI, AP approach

TF-ESI at L5 and S1

Smith’s Principles • If everything seems to be going well, you obviously do not know what is going on. • If it happens, it must be possible. • If you are already in a hole, there is no use to continue digging it. • If you don’t know what you are doing, do it neatly. • If you have nothing to do, don’t do it here.

Lumbar Discography

Lumbar discography

Lumbar Discography (needleinside-needle)

Nucleoplasty/Percutaneous Diskectomy

Lumbar Sympathetic Block

Hypogastric Plexus Block

Ganglion Impar Block

Vertebroplasty and Khyphoplasty

Vertebroplasty and Khyphoplasty

Vertebroplasty and Khyphoplasty

Vertebroplasty and Khyphoplasty

Sacroiliac Joint Injection

Hip and Knee injection

• Less the indications, more the complications • If a patient doesn’t believe the injection will help, it may still work, but if you don’t believe, then it will definitely not work. • Learn when to stop and when to say no.

Suggest Documents