Thx for this lecture. Why don't you use the loss of resistance technique to be sure not to puncture to the dural layer? I have got so much experience with interlaminer epidural injection by loss of resistance method but I don't have confidence to me for your technique. Maybe I will try it when I get more adept on interventional procedure.
The loss of resistance technique and the use of contrast media infiltration both serve the same purpose, which is to help identify the correct space during a medical procedure. The loss of resistance technique involves the use of a fluid, such as saline, that is used to help identify a specific space, while the use of contrast media infiltration involves the injection of a radiopaque contrast material to visualize the space under imaging. Both methods are used to confirm the correct placement of a needle, catheter, or other instrument during a procedure. The loss of resistance technique is considered less definitive than contrast media infiltration, as the presence of contrast material provides a clear and unmistakable visualization of the targeted space. Overall, both methods have their advantages and disadvantages, and the choice of technique may depend on the specific procedure, the experience and preference of the practitioner, and other factors.
Hi Dr, is PRP cervical epidural high risk when there is already severe central/foraminal stenosis with cord compression? Can injecting PRP when there is already minimal space cause even further cord compression and possible hemetoma? Thanks.
Great dr. Lee. How much drugs and what drugs did you do. And in what level you did block, is it VC7-VTH1. Is it amount of drug depend from how much level you want to cover. And what about technique of loss resistance dod yoo use. Thank you.
I use 2ml of dexamethasone palmitate in total. it will be 5mg of dexamethasone equivalent. I mixed it with 1ml of local anesthetics. so, 3ml of fluid covers the whole cervical spine if the fluid flow to the wanted direction by parasagittal approach.
There are numerous lecture videos available demonstrating the degree of C-arm angulation. I recommend finding and watching them to gain a better understanding
Nice job! Dr. Lee! It is a very educational video. What kind of do you use in cervical epidural steroid injection? It looks like triamcinolone. Is it right?
Thank you for your comment. In the cervical area, triamcinolone is forbidden because is a particulate steroid. I always use dexamethasone palmitate, the brand name is "Limethason"
@@practicalpainmanagementwit8115 so it mean Limethason is only best choice for cervical spine. I think Triamcinolone is a particle so it is dangerous to use in cervical spine.
If Iam not wrong your needle was on right side and c-arm recorder was tilted to the left and the vice versa if the needle is on the left side..Am I right. kindly clarify..
How do you position the patient. I find it difficult to do this injection with patient in prone position.. Any tips in positioning of patient will be acknowledged.
prone position as we watch at the video. maybe you ask your technician to align well the cervical disc plane on AP and turn obliquely to well visualize the tangential angle to the lamina.
I think it's about the height of the c arm from the patient. Scatter radiation. But I think it's ok the sensor should be closer to the patient not the source...
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very well demonstrated .
thank you
많은 도움이 되었습니다 좋은 영상 감사합니다.
감사합니다
선생님 감사합니다. 전문의 딴지 2년차된 꼬꼬마입니다. 덕분에 많은 도움 되고 있습니다.
도움이 되셨다니 감사합니다
Awesome technique
Thank you! Cheers!
Good educational video.
thank you
Thx for this lecture. Why don't you use the loss of resistance technique to be sure not to puncture to the dural layer?
I have got so much experience with interlaminer epidural injection by loss of resistance method but I don't have confidence to me for your technique.
Maybe I will try it when I get more adept on interventional procedure.
The loss of resistance technique and the use of contrast media infiltration both serve the same purpose, which is to help identify the correct space during a medical procedure. The loss of resistance technique involves the use of a fluid, such as saline, that is used to help identify a specific space, while the use of contrast media infiltration involves the injection of a radiopaque contrast material to visualize the space under imaging.
Both methods are used to confirm the correct placement of a needle, catheter, or other instrument during a procedure. The loss of resistance technique is considered less definitive than contrast media infiltration, as the presence of contrast material provides a clear and unmistakable visualization of the targeted space.
Overall, both methods have their advantages and disadvantages, and the choice of technique may depend on the specific procedure, the experience and preference of the practitioner, and other factors.
Can you do an educational video for transforaminal cervical root block.
I do not perform C arm guided transforaminal anymore. I do ultrasound guided and parasagittal epidural with ipsilateral facet joint injection.
@@practicalpainmanagementwit8115 wow
Great
thank you
At 4:31 it states "ipsilateral oblique rotation" for the C-arm. Did you mean contralateral oblique?
Yes, It is contralateral oblique rotation. thank you for your comment
Hi Dr, is PRP cervical epidural high risk when there is already severe central/foraminal stenosis with cord compression? Can injecting PRP when there is already minimal space cause even further cord compression and possible hemetoma? Thanks.
PRP is not a miraculous solution; be cautious of placing undue trust in such idealistic views.
@@practicalpainmanagementwit8115 In which specific cases do you recommend PRP?
Dr. Lee. Do you use a 20 gauge or 18 gauge Tuohy needle for your cervical and lumbar interlaminar injections? Thank you.
I use 22G 8cm needle for the cervical and lumbar injection.
Great dr. Lee. How much drugs and what drugs did you do.
And in what level you did block, is it VC7-VTH1.
Is it amount of drug depend from how much level you want to cover.
And what about technique of loss resistance dod yoo use.
Thank you.
I use 2ml of dexamethasone palmitate in total. it will be 5mg of dexamethasone equivalent. I mixed it with 1ml of local anesthetics. so, 3ml of fluid covers the whole cervical spine if the fluid flow to the wanted direction by parasagittal approach.
I think dr Lee dondt use loss resistence, he does it just with Carm Anatomy, is it true?
Can we use dexamethasone sodium phosphate in this case doctor lee?
보드10년차, 통증 6년차 접어드는 RM 입니다. 이시기에 봐도 봐도 배울게 있는 영상이네요. CLO 테그닉 있는줄은 알았는데 lat 위주로만 하다가 선생님 영상보고 CLO 적용해봤는데 상당히 편하네요.
혹시 paramedian 접근 CLO는 꽤 편한데, 거의 정 medial 접근시에도 oblique view를 적용해서 갈만한지 여쭙고 싶습니다.
CLO가 laminar의 원통형 사선방향에 plane을 맞추는 원리로 이해하고 있는데..
medial laminar center 면 apex라서 CLO로 laminar 방향을 맞출수 있나하는 의문입니다.
감사합니다. 잘봤습니다 선생님.
midline 이라면 lateral 이 정답인데, CLO로도 비슷하게 맞춤니다. 반드시 lateral 을 해야 하는 것은 아닌 것 같습니다.
@practicalpainmanagementwit8115 앗 선생님 답변 영광입니다. 감사합니다!!
You mean contralateral oblique?
Also question usually how many degrees do you find your optimal view?
There are numerous lecture videos available demonstrating the degree of C-arm angulation. I recommend finding and watching them to gain a better understanding
50 degrees is optimal according to this study. pubmed.ncbi.nlm.nih.gov/28072809/
Nice job! Dr. Lee! It is a very educational video. What kind of do you use in cervical epidural steroid injection? It looks like triamcinolone. Is it right?
Thank you for your comment. In the cervical area, triamcinolone is forbidden because is a particulate steroid. I always use dexamethasone palmitate, the brand name is "Limethason"
But the fluid is so white. Looks like Triamcinolone to me.
@@bizkits2517 dexamethasone palmitate is white color, looks like triam, but is is not.
particular steroid is forbidden in cervical spine
@@practicalpainmanagementwit8115 so it mean Limethason is only best choice for cervical spine. I think Triamcinolone is a particle so it is dangerous to use in cervical spine.
Cuantas veces y cada cuanto tiempo es posible poner la inyeccion
On average 3 times. Each 2 ample of dexamethasone palmitate
Can we use dexamethasone sodium phospate in this case doctor lee?
No, dexamethasone palmitate. You have to increase dosage when you use dexamethasone sodium phosphate.
Because we dont have it in indonesia dr, do u hv any suggestion?and what is the equal dose for dexamethasom sodium phospate?
좋은 영상 감사합니다
저도 감사합니다
Contralateral oblique c-arm view. Why the word rotation added.. does the c-arm needed to be rotated too. Kindly clarify..
patient is in prone, the C arm rotate to contralateral oblique
선생님, 매우 인상 깊게 보았고 저도 현재 이 방법을 따라하고 있습니다. 궁금한 게 있습니다. 혹시, CLO view 맞출 때 C-arm을 몇 도 정도 맞추고 계신가요? 저는 대략 45도 정도 맞추고 하고 있습니다. 좋은 컨텐츠 감사합니다.
많은 동영상에 올려 드렸습니다. 확인 부탁드립니다
감사합니다
If Iam not wrong your needle was on right side and c-arm recorder was tilted to the left and the vice versa if the needle is on the left side..Am I right. kindly clarify..
yes you are right
How do you position the patient. I find it difficult to do this injection with patient in prone position.. Any tips in positioning of patient will be acknowledged.
prone position as we watch at the video. maybe you ask your technician to align well the cervical disc plane on AP and turn obliquely to well visualize the tangential angle to the lamina.
Epidural block의 경우 ap lat을 저장해야하지 않나요
epidural block은 아직 특별한 규정이 없는 것으로 알고 있어요
Will you be able to see if hyoid bone is fractured?
I don't have any experience to hyoid bone fracture.
선생님 영상 잘 보았습니다
병원 알려주실 수 있나요?
전라북도 전주에 있습니다
Excelent
thank you
Why is the II so high. That’s more dose to the patient
what does mean of II ?
Do you mean radiation dose?
@@practicalpainmanagementwit8115ii는 영상증배관의 줄임말입니다. 디텍터쪽에 있습니다
I think it's about the height of the c arm from the patient. Scatter radiation. But I think it's ok the sensor should be closer to the patient not the source...
@@sasquatch4160you know the source is underneath the table so it is closer than the receptor