ohiovolffemtp Posted April 12, 2020 Share Posted April 12, 2020 The title pretty much sums it up. I've had pretty good success with the following for my low back pain patients: If there's palpable spasm or tenderness to palpation of the lumbar paraspinal muscles: trigger point injections If there's tenderness on palpation of the notch above the junction of the iliac crest and the sacrum: block the sciatic nerve by using a 1.5" or longer needle to infiltrate 5 ml of a mix of lidocaine & marcaine in a fan pattern. If there's tenderness on palpation of the piriformis muscle, usually in the area on the underside of the ilium just lateral to the sacrum, inject the piriformis muscle by using a 1.5" or longer needle to infiltrate 5 ml of a mix of lidocaine & marcaine in a fan pattern. I use about 20% lidocaine to get rapid onset and 80% marcaine to get 6-8 hours duration of action. In some cases I have to use spinal needles for the larger body habitus patients. It's not the 100% silver bullet, but works very well about 80% of the time. It seems to work faster and better than my old approach of IM toradol and IM or PO cyclobenzaprine. I'm also having pretty good success with rib blocks for rib fractures and pleuritic pain. Haven't had an occasion to try on shingles, but plan to. Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 12, 2020 Moderator Share Posted April 12, 2020 Nice work! I’ve recently added erector spinae plane blocks. It’s been working great for my low back pain patients no matter the cause. It’s become my go to block as it’s very easy with low risk. I’ve yet to try it for abdominal pain, though I’m interested to try. Would also like to try it for rib pain, but still doing rib blocks for that as of now. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted April 12, 2020 Moderator Share Posted April 12, 2020 I do the trigger point injections, but none of the others. Need to read up I guess. Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted April 12, 2020 Author Share Posted April 12, 2020 LT, are you doing the erector spinae blocks by landmarks or under U/S? Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted April 12, 2020 Moderator Share Posted April 12, 2020 50 minutes ago, ohiovolffemtp said: LT, are you doing the erector spinae blocks by landmarks or under U/S? Ultrasound. Makes an easy block ridiculously easy. Quote Link to comment Share on other sites More sharing options...
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