Epidural Steroid Injection (ESI) For Back Pain – Interventional Pain Management

Epidural Steroid Injection (ESI) For Back Pain – Interventional Pain Management

August 20, 2019 0 By William Morgan


– So, procedure.
We already have the sterile
prep with the iodine.
Then I just put this
drape over you so that
if I lean on your skin I
won’t contaminate the area.
Just gives you a wider field.
Okay, now we do the
marker and the numbing.
Confirming we’re doing the right side.
I’m placing my marker,
it looks like it should
(mumbles) pretty much on target.
Alright, so I’m just gonna go a little
above that to numb you, alright?
I’m putting the numbing medication in now.
Did you feel anything?
– Yeah.
– Just a little pinch, right?
Not terrible?
That’s me making a skin wheel.
You can see, that’ll make it so it…
see that right there, the
little dimpling on the skin?
You can see that.
That’ll make it so that
when I put the tuohy needle,
which is this, he won’t feel it.
You wait about a minute
because it takes the lidocaine
a while to work, so we wait.
Alright.
Try to follow the angle of the seat arm.
You see that I’m on the right side,
which is where I wanna be.
I just…
Let’s take a lateral picture.
The lateral picture is to gauge the depth.
Picture.
– Need it a little lower?
– A little lower.
I can see that we still
have some ways to go.
That’s more clear.
Basically, the target is that
line, the spinolaminar line.
You can continue taking
the lateral picture.
We’re close.
That was loss of resistance.
You can go back to AP, Raphael.
I’m gonna inject some contrast.
Let’s just take one in this view.
Alright, yeah, we can see
the contrast right in there.
Alright, that’s good.
Basically contrast is
only on the right side
and there’s this bubbling pattern
that’s consistent with
epidural fluid space.
Just inject the medication.
Wash out photo.
We’re done.
– That’s it?
– Yeah, and the patient says, “That’s it”.