Difference between revisions of "BWH Pain Attending Preferences"

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=== Dr. Srdjan Nedeljkovic ===


* Writes his own procedure notes and does his own telehealth and virtual visits
* Sometimes “runs the list” of clinic patients with you in the AM
* Always try to order 5 ml vial of Depo-Medrol if available except for TPIs (specifically order 200 mg otherwise defaults to multiple 1 ml vials)
* Punctual with clinic and procedures
* Wear a mask for procedures
* Weekend call: meet ~ 6:30 AM without pre-rounding
* Stays in hospital until morning notes are completed
* Baclofen Single Shot (with Fluoroscopy)
* Medications to Order: Baclofen 50 to 75 mcg/ml (Confirm dose with attending)
* Procedure: Spinal kit with 25 G Whitacre
'''Caudal Epidural Steroid Injection'''
* Medications to Order:
* Lidocaine 0.5% (50 mL)
* Omnipaque
* Depo-Medrol 40 mg/mL (5 mL vial)
* Procedure:
* #17 gauge Weiss needle
** Inserts catheter midline to ~ L5 or S1
** Confirmation with contrast in lateral + AP views
* Inject 120 mg methylprednisolone followed by 3 mL 0.5% lidocaine
'''Cervical Epidural Steroid Injection'''
* Medications to Order:
* Lidocaine 0.5% (50 mL)
* Depo-Medrol 40 mg/mL (5 mL vial)
* Procedure:
* Contralateral oblique view
* LOR to air with glass syringe
* Attach tubing to epidural needle and drip to gravity through glass LOR syringe
** Administer 120 mg methylprednisolone followed by 3 mL 0.5% lidocaine
Cervical Medial Branch Block
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* Patient prone (A-P mid-point of articular pillar)
* Injectate (per level): 20 mg Depo-Medrol + 1 mL 0.25% bupivacaine
* 3.5 inch 22-gauge spinal needle
Genicular Nerve Block:
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate: 40 mg Depo-Medrol + 4 mL 0.25% bupi at each of the 3 levels
Intercostal:
2 bupi 2 steroid at each level
Usually fluoro but can be U/S, he does both
Knee Intra-Articular Steroid
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate: 6 mL 0.25% bupivacaine + 80 mg Depo-Medrol
* Fluoroscopy with 3.5 inch spinal needle
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Procedure:
* #17 gauge Weiss needle
* LOR to air with glass syringe
* Confirmation in CLO and lateral views without contrast
* Attach tubing to epidural needle and drip to gravity through glass LOR syringe
** Administer 120 mg methylprednisolone mixed with 3 mL 0.5% lidocaine, then draw up 3cc of lido to chase the mixture in 3cc syringe after drip to gravity
Lumbar Medial Branch Blocks
Medications to Order:
0.5% lidocaine (50 mL)
0.25% bupivacaine (10 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Procedure:
* #22 gauge 3-½ inch spinal needle
* Injectate: 1 mL of 0.25% bupivacaine + 20 mg methylprednisolone at each level
** Inject methylprednisolone then bupivacaine separately
* AP-only
Lumbar Radiofrequency Ablation:
Medications to Order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL)
Procedure:
Lumbar Transforaminal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg
Bupivacaine 0.25% (10 mL)
Contrast
Procedure:
* Pointer initially in AP at lateral inferior edge of transverse process
* Transition from AP to oblique with pointer in place
* Bent 22-gauge 3.5 inch spinal needle
* Injectate: 5 mg dexamethasone + 1 mL 0.25% bupivacaine per level
Sacroiliac Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial) > does 120
Bupivacaine 0.25% (10 mL)
Procedure:
* Medial to lateral approach (intra-articular)
* If unilateral, three #22-gauge 3-½ inch spinal needles (superior; middle; inferior pole)
** 40 mg Depo-Medrol and 3 mL 0.25% bupivacaine into each needle
* If bilateral, two #22-gauge 3-½ inch spinal needles (midde; inferior pole) each side
** 30 mg Depo-Medrol and 3 mL 0.25% bupivacaine into each needle
Shoulder Injection with Fluoroscopy
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL
Bupivacaine 0.25% (10 mL)
Procedure (Glenohumeral):
* Lateral to medial approach
* #22-gauge 3-½ inch spinal needle
* Injectate: 40 mg Depo-medrol + 5 mL 0.25% bupivacaine
Procedure (Acromioclavicular):
* #25-gauge 1-½ inch local needle
* Injectate: 40 mg Depo-medrol + 1 mL 0.25% bupivacaine
Sphenopalatine Ganglion Block
Medications to Order:
Bupivacaine 0.5%
Procedure:
* Cotton swab
TAP Block (Ultrasound)
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate: 18 mL 0.25% bupivacaine + 80 mg Depo-Medrol
* Needle insertion (Pajunk) from medial to lateral
Trigger Point Injections
Medications to Order:
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg/mL (1 mL vial)
Procedure:
* Injectate: 1 mL methylprednisolone (40 mg) + 9 mL 0.25% bupivacaine
== Dr. Pritesh Topiwala ==
- Prefers help with telehealth and sometimes with virtual visits
- For Hale - 1st floor Daniel Ponton Teaming Room
- For procedure notes, copy forward prior progress note and add procedure note
- For progress notes, often keeps prior “Interval History”
- For FXB, order fluoroscopy with meds
Confirm availability of Depo-Medrol
Exchange bupivacaine 0.25% 1:1 with ropivacaine 0.5%
Caudal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
80 mg Depo-Medrol
Procedure:
* Injectate: 5 mL 0.5% lidocaine + 80 mg Depo-Medrol
* Attempts amLess with 25 G 1.5 inch “local” needle
* Confirms with contrast
Cervical Medial Branch Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg/mL (1 mL vial)
Procedure:
* #25 gauge spinal needle
** Single needle x3 positions
* Lateral positioning for diagnostic blocks
* 0.75 mL injectate per position (injectate consists of 1 mL dexamethasone and 1.5 mL 0.5% lidocaine)
Genicular Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
60 mg Depo-Medrol
Procedure:
* Injectate: 20 mg Depo-Medrol + 1 mL 0.25% bupivacaine per site
Knee Intra-Articular Steroid with Fluoroscopy
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
40 mg Depo-Medrol or 40 mg Kenalog
Procedure:
* Pointer needle
* Use 1.5 inch 25-gauge local needle if amLess to joint if feasible
* Confirm with lateral fluoroscopy
* Injectate: 3 mL 0.25% bupivacaine + 1 mL steroid (40 mg Depo or 40 mg Kenalog)
Greater Trochanteric Bursa Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Palpation landmark technique
* Injectate: 40 mg Depo-Medrol + 4-6 ml 0.25% bupivacaine
Hip Intra-articular Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Supine fluoroscopy  
* Injectate: 40 mg Depo-Medrol + 4-6 ml 0.25%
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque 300 mg
Procedure:
* Loss-of-resistance to 3 mL contrast syringe
* Injectate: 80 mg Depo-Medrol + 3 ml 0.5% lidocaine
Lumbar Medial Branch Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque 300 mg
Procedure:
* 22-gauge 3.5 inch spinal needle
* - Injectate: 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine (1 mL per level)
Lumbar Transforaminal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg (1 mL)
Procedure:
* 22-gauge 3.5-inch needle
* Injectate: 1 mL 0.5% lidocaine + 10 mg (1 mL) dexamethasone per level
Sacroiliac Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
80 mg Depo-Medrol
Procedure:
* Injectate: 3 mL 0.25% bupivacaine + 40 mg Depo-Medrol
* Intra-articular approach
Trigger Point Injections
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
40 mg Depo-Medrol or 40 mg Kenalog
Procedure:
* Injectate: 5 mL 0.5% lidocaine + 5 mL 0.25% bupivacaine + 10 mg Depo-Medrol
== Dr. Edward Michna ==
- Do not bend spinal needles
- Does his own telehealth and virtual visits
- Will see opioid refills alone and usually  marks his initials
- No lidocaine in epidural space (steroid and normal saline only)
Caudal Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (80 mg total)
Omnipaque 300 mg
Procedure:
* 17 G epidural needle (no catheter)
* + Contrast
* Large volume injectate ~ 8-10 ml total (6-8mL NS + 80 Depo-Medrol)
Cervical Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (80 mg total)
NO OMNIPAQUE
Procedure:
* Hanging drop technique with patient in sitting position (lateral fluoroscopy)
** Prepare 3-mL syringe with normal saline and needle to add “drops” to epidural needle
* Attach tubing to epidural needle (preferably assistant so that the operator maintains control of needle)
* Drip to gravity through glass LOR syringe
** 80 mg methylprednisolone followed by 2-3 mLs of normal saline
Cervical Medial Branch Blocks
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (80 mg total)
Procedure:
* Patient prone (A-P mid-point of articular pillar)
** Confirmation in lateral view
* Injectate (per level): 20 mg Depo-Medrol + 1 mL 0.5% lidocaine
* 3.5 inch 22-gauge spinal needle
Genicular Nerve Block
Medications to Order:
Depo-Medrol 80 mg (2 mL)
Bupivacaine 0.25% (10 mL)
Lidocaine 0.5% (50 mL)
Procedure:
* Injectate: 20 mg Depo-Medrol + 2-3 mL 0.25% bupivacaine per level
* Superolateral + superomedial + inferomedial
Genicular RFA
Medications to Order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5cc)
Hip Injection: Greater Trochanteric Bursa
Medications to Order:
Depo-Medrol 40 mg (1 mL)
Bupivacaine 0.25% (10 mL)
Lidocaine 0.5% (50 mL)
Procedure:
* Injectate: 20-40 mg Depo-Medrol + 2 mL 0.25% bupivacaine per side
Knee Intra-Articular with Synvisc
Medications to Order:
Lidocaine 0.5% (50 mL)
Synvisc 2 mL (16 mg)
Procedure:
* Pointer needle
* Exchange local anesthetic needle for 3.5 inch 22-gauge spinal
* Confirm with lateral fluoroscopy, meet the osseous border
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (80 mg total)
Procedure:
* LOR to glass syringe with air (17 or 20 G epidural needle)
** Lateral or CLO confirmation
** No contrast
* Attach tubing to epidural needle
* Drip to gravity through glass LOR syringe
** 80 mg methylprednisolone followed by 2-3 mLs of normal saline
Lumbar Medial Branch Blocks
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 60 mg per side (120 mg bilateral)
Procedure:
* 20 Depo-Medrol + 1 mL bupivacaine 0.25 ml each level
* Inject lidocaine with needle removal
* Confirm with lateral fluoroscopy
*
Lumbar Radiofrequency Ablation
Medications to Order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL)
Procedure:
* Cephalad tilt of fluoroscope (angled towards feet)
* One RFL lesion at a time
* Confirms RFL probes in lateral position
** Multiple checks (ask patient to hold breath) with testing and 2% lidocaine
Lumbar Transforaminal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg (1 mL)
Procedure:
* 22-gauge 5-inch needle
* Injectate: 1 mL 0.5% lidocaine + 10 mg (1 mL) dexamethasone per level
* Do not bend needle
Sacroiliac Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: 2 mL bupivacaine 0.25% + 40 mg Depo-Medrol
* Single injection at inferior pole of joint
* Confirm with lateral fluoroscopy
Trigger Point Injections
He’s okay with you starting without him
Medications to Order:
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: 9 mL 0.25% bupivacaine + only 20mg Depo-Medrol (usually)
** Varies injectate with frequency of TPIs and history of diabetes mellitus
[Dr. Ed Ross]
- Does his own telehealth and virtual visits
- Often sees patients on his own (and performs pump refills)
- High level of autonomy afforded to residents and fellows
Baclofen Single Shot
Medications to Order:
Baclofen 50 mcg/ml if ambulatory
Confirm dose with attending
Procedure:
* Sitting or lateral decubitus per patient comfort
* Spinal kit with 25 G Whitacre
Botulinum Toxin (BOTOX)
Medications to Order:
Botulinum toxin type A injection 100 units
Procedure:
* Doesn’t always use “migraine protocol”
Caudal Epidural Steroid Injection
Medications to order:
Lidocaine 0.5%
Methylprednisolone 40 mg/mL (80mg total)
Procedure:
* Injectate: 80 mg methylprednisolone + 3-4 mL 0.5% lido
* Can use 25 g 1.5 inch finder needle to amLess space (by palpation if possible) with fluoro to confirm or reposition
* No contrast
Cervical Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (80 mg total)
Procedure:
* Hanging drop technique with patient in sitting position (lateral fluoroscopy)
Cervical Medial Branch Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Methylprednisolone 80 mg
Procedure:
* Injectate (per level): 20 mg methylprednisolone + 0.5-1 mL 0.25% bupivacaine
* 25-gauge 2.5 inch needle
* AP fluoroscopy targeting pedicle
Greater Trochanteric Bursa Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* No fluoroscopy or contrast
* Injectate: 40 mg Depo-Medrol + 4 mL 0.25% bupivacaine
Hip Intra-Articular Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* Fluoroscopy with 22G 3.5 inch spinal needle
* Injectate: 40 mg Depo-Medrol + 4 mL 0.25% bupivacaine
Knee Intra-Articular Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Procedure:
* Landmark or fluoroscopy
* Injectate: 40 mg Depo-Medrol + 4 mL 0.25% bupivacaine
Lumbar Medial Branch Blocks
Medications to order:
Lidocaine 0.5% (50 mL)
Methylprednisolone 40 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* AP views only
* No specific injectate preference
Piriformis Injection
Medications to order:
Methylprednisolone 40 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* Landmark (palpation) technique
* Injectate: 10-20 mg methylprednisolone + 5 mL 0.25% bupivacaine
Pump Refill
Procedure:
* Use pump refill template
Sacroiliac Joint Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Methylprednisolone 40 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* AP views only
* Periarticular injection x2 (inferior pole and ~ ⅓ distance above inferior pole)
* Injectate: 10-20 mg Depo-Medrol + 1 mL 0.25% bupivacaine per needle
Thoracic Medial Branch Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Methylprednisolone 80 mg
Procedure:
* Injectate (per level): 20 mg methylprednisolone + 0.5-1 mL 0.25% bupivacaine
* 25-gauge 2.5 inch needle
* AP fluoroscopy targeting pedicle
Trigger Point Injections
Medications to Order:
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg/mL (1 mL)
Procedure:
* Injectate: 1 mL methylprednisolone + 9 or 10 mL 0.25% bupivacaine
== Dr. Jason Yong ==
- Does his own telehealth and sometimes does his own virtual visits
Prefers help with telemedicine if “complete downtime”
- Writes his own procedure notes
- Writes his own operative notes
- For Faulkner - do not place medication orders
- For Hale - 1st floor Daniel Ponton Teaming Room
Botox for migraines
Caudal Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg (2 mL)
Procedure:
* Start with lateral image
* Injectate: 6 ml 0.5% lidocaine + 80 mg Depo-Medrol
Celiac Plexus Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Start AP to identify TP of L1 then ipsilateral (L) oblique until TP lines up with lateral edge of vertebral body
* Advance needle co-axial to lateral edge of L1 vertebral body and transverse process
* Advance through aorta (consider removing stylet to visualize blood) then advance again through back wall (i.e. through and through method)
* Injectate: 80 mg Depo-Medrol + 8-9 mL 0.25% bupivacaine (10 mL total)
Cervical Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Loss-of-resistance to 3 mL contrast syringe
* Confirmation in CLO view
* Injectate: 80 mg Depo-Medrol + 3 ml 0.5% lidocaine
Cervical Medial Branch Block
Medications to order:
Bupivacaine 0.25% or 0.5% (10 mL)
Dexamethasone 10 mg
Lidocaine 0.5% (50 mL)
Procedure:
* 4 levels with 1.5 inch 25-gauge local anesthetic needle (single needle technique)
* Lateral position
* Injectate: 10 mg dexamethasone + 3 mL 0.5% bupivacaine (1 mL per level)
Epidural ITP Trial (for non-malignant pain)
Medications to order:
* 0.0625% bupivacaine + 20 mcg/ml hydromorphone (confirm with Jason)
For the OR:
* Periflex catheter set (1.5% lido with epi and Chloraprep inside kit) + Epimed epidural needle (x2 if tunneling) + Epimed epidural catheter + StayFix
* C-arm + drape
* 1000 drapes + blue towels + ½ sheet
Post-op:
* Admit to ERU/23h inpatient for titration
* Start with 0.0625% bupivacaine + 20 mcg/mL hydromorphone at 6 mL/hr
** If necessary to increase density, increase to 40 mcg/mL or 60 mcg/mL hydromorphone mix
Ganglion Impar
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Omnipaque
Procedure:
* Lateral fluoroscopy
* Confirm with contrast
* Injectate: 5 mL bupivacaine 0.25% + 40 mg Depo-Medrol
Knee Intra-Articular Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% (10 mL)
Procedure
* Landmark technique
* Injectate: 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine + 2 mL 0.5% lidocaine
Lumbar Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Loss-of-resistance to 3 mL contrast syringe
* Confirmation in CLO view
* Injectate: 80 mg Depo-Medrol + 3 ml 0.5% lidocaine (5 mL total volume)
Lumbar Medial Branch Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Single needle technique (bent) 22 or 25 gauge
* Injectate: 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine (1 mL per level)
Lumbar Radiofrequency Ablation
Medications to order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL)
Procedure:
* AP for SA needle then “Scotty dog”
* 2 minute lesion followed by 180 degree turn of needle then 2 minute repeat lesion
Lumbar Sympathetic Block
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% (10 mL)
Omnipaque
Procedure
* Injectate: 40 mg Depo-Medrol + 10 mL 0.25% bupivacaine
Occipital Nerve Block
Medications to order:
Lidocaine 2% (5 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: 1 ml 40 mg/ml Depo-Medr ol + 4 ml 2% lidocaine
* 30 gauge 0.5 inch needle
* 1 ml at each LONB, 1.5 ml at each GONB
Pump Refill
Procedure:
* Use ultrasound to identify refill port
** Mark with marker or imprint skin with cap
Sacroiliac Joint Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* Target lateral border of S1 + S2 + S3 foramen and SA
* Two needles: first target S1 and S3 - second target SA and S2
* Injectate for unilateral: 40 mg Depo-Medrol + 3 mLs 0.5% bupivacaine (1 mLs each level)
* Injectate for bilateral: 80 mg Depo-Medrol + 7 mLs 0.5% bupivacaine
Stellate Ganglion Block
Medications to order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* Ultrasound-guided (in-plane)
* Injectate: 10 mg dexamethasone + 8-9 mL 0.25% bupivacaine
Transforaminal Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Dexamethasone 10 mg
Omnipaque
Procedure:
* Injectate: 10 mg dexamethasone + 1 mL 0.25% bupivacaine or 1 mL 0.5% lidocaine
** If 2 levels, draw up 10 mg dex + 3 mL 0.25% bupivacaine for total of 2 mL at each level
== Dr. Ehren Nelson ==
- Predominantly dexamethasone as steroid choice
- Prefers help with telemedicine and virtual visits
- For Faulkner - do not place medication orders
Cervical Epidural Steroid Injection
Medications to Order:
Dexamethasone 10 mg
Lidocaine 0.5% (50 mL)
Omnipaque
Procedure:
* Injectate: 10 mg dexamethasone + 3-4 mL 0.5% lidocaine
* LOR with contrast syringe
* 20-gauge Weiss needle
Cervical Medial Branch Block
Medications to Order:
Dexamethasone 10 mg
Lidocaine 0.5% (50 mL)
Procedure:
* Patient in lateral position (AP films) aim for middle of lateral mass
* Injectate (3 levels): draw up 10 mg dexamethasone + 1.5 mL 0.5% (or 2%) lidocaine → 3.3 mg dexamethasone + 0.5 mL 0.5% lidocaine at each level
Lumbar Epidural Steroid Injection
Medications to Order:
Dexamethasone 10 mg
Lidocaine 0.5% (50 mL)
Omnipaque
Procedure:
* Injectate: 10 mg dexamethasone + 3-4 mL 0.5% lidocaine
* LOR with contrast syringe
* 20-gauge Weiss needle
Transversus Abdominis Plane Block
Medications to Order:
Dexamethasone 10 mg
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate: 10 mg dexamethasone + 9 mL 0.5% bupivacaine
* Prepare two additional 5 mL syringes of 0.5% lidocaine
Shoulder Glenohumeral Joint Injection with Ultrasound (Posterior Approach)
Medications to Order:
Depo-Medrol 40 mg
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Procedure:
* Patient in prone or lateral position → place ultrasound on posterior shoulder to identify triangle
* Injectate: 40 mg Depo-Medrol + 3 mL 0.25% bupivacaine
== Dr. Mo Issa ==
- For procedure notes, carry forward prior follow-up notes and embed procedure note
- For Faulkner - do not place medication orders
- Weekend call: Prefers pre-rounding (meet at ~ 8 or 9 AM)
- Contrast for: synvisc, LESI, (most things)
Cervical Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg
Omnipaque
Procedure:
* Injectate: 10 mg dexamethasone + 3 mL 0.5% lidocaine
* Loss of resistance to tubing + contrast
Cervical Medial Branch Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Lateral positioning if unilateral at higher than C5
** Prone positioning if bilateral or C5 and lower
* Injectate: 10 mg dexamethasone + 2-3 mL 0.25% bupivacaine (1 mL per level)
Cluneal Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Target 3 points along iliac crest
* Injectate (therapeutic): 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine (1 mL per level)
* Injectate (diagnostic): 3 mL 2% lidocaine (1 mL per level)
Genicular Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
- Injectate: 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine (1 mL per site)
Greater Trochanteric Bursa Injection - Fluoroscopy
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Procedure:
- Lateral position with target hip up
- Take lateral images
- Injectate: 40 mg Depo-Medrol + 4 mL 0.5% lidocaine
- No contrast
Hip Injection Intra-articular - Fluoroscopy
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
- Supine position
- Injectate: 40 mg Depo-Medrol + 4 mL 0.5% lidocaine
- Yes contrast
- Lateral to medial trajectory
Hypogastric Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Omnipaque
Procedure:
* Injectate: 5 mL bupivacaine 0.25% + 5 mL lidocaine 5% + 40 mg Depo-Medrol
* Target at anterolateral surface of L5
* Confirmation with contrast
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Procedure:
* Injectate: 80 mg Depo-Medrol (2 mL) + 4 mL 0.5% lidocaine
* No preference in terms of LOR technique
Lumbar Medial Branch Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Enter needle coaxial ipsilateral oblique Scotty dog
** Sometimes opts for AP if bilateral
* Injectate: 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine (1 mL per level unilateral) or 80 mg Depo-Medrol + 4-5 mLs of 0.25% bupivacaine (1 mL per level bilateral)
Lumbar Radiofrequency Ablation
Medications to order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL) - 1cc in each
Procedure:
* AP for SA needle then “Scotty dog” for L4 and L5 (co-axial)
** Start with caudal tilt; “walk off” anteriorly after contacting bone
** 18G needles
Piriformis
Medications to order:
Lidocaine 0.5% (50 mL)
Bupi 0.25%
Depo 40
Procedure:
* Fluoro
* Mix 2cc lido, 2cc bupi, 1cc depo
* Come in at the joint, retract, angle 45 degrees, readvance, inject
Shoulder Injection Intra-articular with Fluoro
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
- Supine position
- Injectate: 40 mg Depo-Medrol + 4 mL 0.5% lidocaine
- Yes contrast
Sacroiliac Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Dreyfuss (4 sites; 2 needles) + SI intra-articular joint injection
** Needle 1 targets SA + S2; needle 2 targets S1 + S3 + intra-articular
* Injectate: 40 mg Depo-Medrol + 4 mL 0.25% bupivacaine (1 mL per site)
Suprascapular Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: 40 mg Depo-Medrol (1 mL) + 3 mL 0.5% lidocaine
Supraorbital Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Dexamethasone (1cc, 10mg/cc)
Procedure:
* Injectate: 5 dexamethasone plus even mix of lido/bupi per side, aim for 2cc per side
Transforaminal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg
Omnipaque
Procedure:
* Injectate (per level): 10 mg dexamethasone + 1 ml 0.5% lidocaine
* Yes contrast
Trigger Point Injections
Medications to Order:
0.5% lidocaine
+/-40 mg Depo-Medrol
Procedure:
- Injectate: lidocaine 0.5% +/- Depo-Medrol (10-20 mg total)
- usually does just lido
Lumbar Sympathetic Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate (per level): 80 mg Depo-Medrol + 7 mL bupivacaine 0.25% + 7 mL 0.5% lidocaine (total 15 mL injectate)
* Yes contrast
** Inject in lateral view to visualize needle tip anterior to vertebral body
Occipital Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 80 mg
Procedure:
* Injectate (per site): 40 mg depo-medrol + 3 mL 0.5% lidocaine and 3 mL 0.25% bupivacaine to be divided between GON and LON (GON on each side - 2-3 mL and LON 1 mL)
== Dr. Christopher Gilligan ==
- Does his own telehealth but prefers help with virtual visits
- For Hale - 1st floor Daniel Ponton Teaming Room
- Prefers lidocaine 1% for subcutaneous infiltration
- Label all syringes on tray
- Often takes images of local needle after skin infiltration to establish trajectory
Caudal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 80 mg
Omnipaque 300 mg
Procedure:
* Prone position with lateral fluoroscopy
* 25 gauge spinal or local needle
* Yes contrast
* Injectate: 80 mg methylprednisolone + 2 mL normal saline +1 mL lidocaine (5 mL total)
Cervical Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 80 mg
Omnipaque 300 mg
Procedure:
* LOR to 2 mL air + 2 mL normal saline
* Starts AP then goes lateral (no CLO)
** Returns to AP for one additional shot after contrast
* Injectate: 80 mg methylprednisolone + 1 mL normal saline (3 mL total)
Cervical Radiofrequency Ablation
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Lidocaine 2% (5 mL)
Greater Trochanteric Bursa Injection with Fluoro
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% (10 mL)
Omnipaque 300 mg
Procedure:
- Lateral position target hip up
- Take lateral images
- Injectate: 40 mg Depo-Medrol + 1 mL 0.25% bupivacaine + 1 mL 0.5% lidocaine  
- Yes contrast
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 80 mg
Omnipaque 300 mg
Procedure:
* LOR to 2 mL air + 2 mL normal saline
* Starts AP then goes lateral (no CLO)
** Returns to AP for one additional shot after contrast
* Injectate = 80 mg methylprednisolone + 1 mL 0.5% or 1% lidocaine (3 mL total)
Lumbar Radiofrequency Ablation
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Lidocaine 2% (5 mL)
Procedure:
* 22-gauge radiofrequency needle
Piriformis Injection (Fluoroscopy)
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 40 mg
Omnipaque 300 mg
Procedure:
* 25-gauge 2.5 inch needle
* Injectate: 2 mL of normal saline + 40 mg Depo-Medrol
Transforaminal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Dexamethasone 10 mg
Omnipaque 300
Procedure:
* Injectate: 10 mg dexamethasone + 1 ml 0.5% lidocaine
* Yes contrast
Trigger Point Injections
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Bupivacaine 0.25% 30 mL
Procedure:
* Injectate: lidocaine 0.5% + bupivacaine 0.25%
* No steroid (only for occipital nerve block)
Sacroiliac Joint Intra-articular Injection
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% 30 mL
Procedure:
- Injectate: 1 mL 0.5% lido + 1 mL 0.25% bupi + 40 Depo-Medrol (3 mL total)
Shoulder Intra-articular with Fluoro (AC joint)
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% 30 mL
Procedure:
- Supine position
- Injectate: 2 mL 0.5% lido + 2 mL 0.25% bupi + 40 mg Depo
== Dr. Danielle Sarno ==
- Provides fellows with print-out of procedures including patient history and relevant imaging findings
- Sometimes prefers personal .DS smartphrases for procedure notes
- Include .name and .DOB on procedure notes
- Include pre-procedure and post-procedure diagnosis and pre-procedure and post-procedure pain scores (VAS)
- Prefers you monitor and help the patient out of the room post-procedure
Cervical Medial Branch Blocks
Medications to Order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL)
Procedure:
* Injectate: 0.5 mL lidocaine 2% (for diagnostic)
* Prone positioning
** Needle insertion and target location identical to cervical RFL
Cervical Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Omnipaque
Dexamethasone
Procedure:
* Injectate: Dex 10mg
* Prone positioning
** No higher than C6-C7
Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Injectate for lumbar: 2 mL 0.5% lidocaine + 2 mL (80 mg) methylprednisolone
* Injectate for cervical: 2 ml 0.9% NS + 1 mL (10 mg) dexamethasone
* Prefers continuous LOR technique (half saline and half air) with one hand driving needle and one hand on syringe
** Careful confirmation with contrast in AP and CLO views
** Attentive to epidural contrast pattern
Lumbar Medial Branch Block
Procedure
* Injectate (if for diagnostic only): 0.7 mL 0.25% bupi per level
Lumbar Radiofrequency Nerve Ablation
Medications  to Order:
Lidocaine 2% (5 mL)
Lidocaine 0.5% (50 mL)
Piriformis Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% (10 mL)
Omnipaque
Procedure:
* Injectate: 40 mg Depo-medrol + 1 mL 0.25% bupivacaine + 1 mL 0.5% lidocaine
* Confirmation with contrast (fluoroscopy)
* Needle insertion mid-point between posterior SIJ and greater trochanter
Sacroiliac Intra-articular Injection
Medications  to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol (40 mg)
Bupivacaine 0.25%
Procedure
* Injectate: 1 ml 0.25% bupi + 1 ml (40 mg) Depo + 1 ml 0.5% lido (3 mL total)
* Target inferior pole of sacroiliac joint (single injection)
Transforaminal Epidural Steroid Injection
Medications  to Order:
Dexamethasone (10 mg)
Lidocaine 0.5% (50 mL)
Procedure
* Injectate (per level): 10 dexamethasone (1 mL) + 1 ml 0.5% lido
** Inject dexamethasone first then lidocaine
* Omnipaque for confirmation with tubing and pulsed live
* 22-gauge 3.5 inch for sacral TFESI and 5 inch for lumbar TFESI
** No preference for bent vs. straight needle
Trigger Point Injections
Medications to Order:
Lidocaine 0.5% (50 mL)
Procedure:
* Injectate: lidocaine 0.5% only***? (unconfirmed)
== Dr. David Janfaza ==
- Weekend call: meet ~ 7:30-8:00 AM (pre-rounding optional)
Checks in later in the day to run through pages
Stays in hospital until morning notes are completed
Cervical Medial Branch Blocks
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol
Bupivacaine 0.25% (10 mL)
Procedure:
* 25-gauge needle
* Injectate: 13 mg Depo-Medrol + 0.5 mL 0.25% bupivacaine
* Lateral positioning
** Confirmation in lateral fluoroscopy
Genicular Nerve Block
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
60 mg Depo-Medrol
Procedure:
* Injectate: 4.5 mL 0.25% bupivacaine + 20 mg Depo-Medrol (5 mL) per level
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol mg
Procedure:
* Injectate: 80 mg Depo-medrol + 2 mL 0.5% lidocaine
* Contrast only in patients with insurance that requires
* Contralateral oblique and lateral
Lumbar Medial Branch Blocks
Medications to Order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 60 mg (unilateral)
Procedure:
* Injectate: 20 mg Depo-medrol + 0.5 mL 0.25% bupivacaine per level
* Slightly oblique
Occipital Nerve Block
Medications to Order:
Bupivacaine 0.25% (10 mL)
40 mg Depo-Medrol
Sacroiliac Joint Injection
Medications to Order:
Bupivacaine 0.25% (10 mL)
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Procedure:
* Injectate: 40 mg Depo-medrol + 1 mL 0.25% bupivacaine
* Intra-articular to inferior pole
Stellate Ganglion Block
Medications to Order:
Bupivacaine 0.25% (10 mL)
Lidocaine 0.5% (50 mL)
Trigger Point Injections
Medications to Order:
Bupivacaine 0.25% (10 mL)
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: 9 mL 0.25% bupivacaine + 40 mg Depo-Medrol
== Dr. Alex Kim ==
- Prefers personal template .AKINITIAL for initial visits
- Writes his own procedure notes
- For Hale - 1st floor Daniel Ponton Teaming Room
Caudal Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Yes contrast
* 22-gauge spinal needle
* Injectate: 80 mg Depo-Medrol + 5-6 mL 0.5% lidocaine
Cervical Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Loss-of-resistance to 3 mL contrast syringe
* Injectate: 80 mg Depo-Medrol + 2 mL 0.5% lidocaine
Epidural Blood Patch
Medications to order:
Lidocaine 0.5% (50 mL)
Omnipaque
Procedure:
* Sterile IV amLess (apply large Tegaderm over inserted IV including extension port tubing)
* Target L5 and S1 interspace
* Injectate: minimum 20 mL blood (target as much as tolerated by patient)
Greater Trochanteric Bursa Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Procedure:
* Lateral with affected side up if unilateral
* Injectate: 40 mg Depo-Medrol + 4-5 mL 0.5% lidocaine
Iliopsoas Injection (Fluoroscopy)
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: ***
Lumbar Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg
Omnipaque
Procedure:
* Loss-of-resistance to 3 mL contrast syringe
* Contralateral oblique imaging
* Injectate: 80 mg Depo-Medrol + 3 ml 0.5% lidocaine
Lumbar Medial Branch Blocks
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg (unilateral) 80 mg (bilateral)
Omnipaque
Procedure:
* Injectate: 40 mg Depo-Medrol + 2 ml 0.25% bupivacaine (1 mL per level)
Lumbar Radiofrequency Ablation
Medications to order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL)
Procedure:
* AP for SA needle placement then “Scotty dog” for L4 and L5
** “Walk off” anteriorly
Sacroiliac Joint Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg (per side)
0.25% bupivacaine 30 mL
Procedure:
* Intra-articular injection + sacral ala
* Injectate: Depo-Medrol 40 mg + 4 mL 0.25% bupivacaine
** 3 mL of injectate intra-articular + 0.5 mL per-articular
** Add 3.5 mL lidocaine to remaining 1.5 mL injectate and inject 4 mL at sacral ala
Shoulder Injection - Glenohumeral plus Subacromial Bursa
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 60 mg
Bupivacaine 0.25% (10 mL)
Omnipaque
Procedure:
* Injectate for GH: Depo-Medrol 40 mg + 3 mL 0.25% bupivacaine
* Injectate for bursa: Depo-Medrol 20 mg + 3.5 mL 0.25% bupivacaine
* For GH: land on humerus at 10-11 o’clock
** Confirm with contrast
* For bursa: land on humerus at 12 o’clock, withdraw ~ 1 cm and advance cephalad
** Confirm with contrast
Trigger Point Injections
Medications to order:
0.25% bupivacaine 30 mL
Depo-Medrol 40 mg
Procedure:
* Injectate: 9 mL 0.25% bupivacaine + 40 mg Depo-Medrol
== Dr. Stephanie Regenhardt ==
- For procedure notes, prefers copy forward of prior notes and embed procedure note
Caudal Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg (2 mL)
Procedure:
* Lateral image
* 22 G 3.5 inch spinal needle
* Injectate: 2 ml 0.5% lidocaine + 2 mL normal saline + 80 mg Depo-Medrol
Genicular Nerve Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 80 mg (2 mL)
Lumbar Epidural Steroid Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 80 mg (2 mL)
Procedure:
* No preference with LOR style, but she does the yellow tuohy with LOR to contrast in 3cc syringe
* Confirmation of depth in CLO
* Injectate: 3 mL lidocaine 0.5% + 80 mg Depo-Medrol
Lumbar Medial Branch Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Procedure:
* Injectate: 40 mg Depo-Medrol + 2 mL 0.25% bupivacaine (1 mL per level)
** In some cases, may do just bupi
* AP + oblique “Scotty Dog” views
* If bilateral, do bottom two first (S1) marked with needles. Then, oblique one side and do L4 and 5 simultaneously, then oblique the other side and do the other two
Lumbar Radiofrequency Ablation
Medications to order:
Lidocaine 0.5% (50 mL)
Lidocaine 2% (5 mL)
Occipital Nerve Block
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg
Sacroiliac Joint Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 80 mg (2 mL)
Procedure:
* Injectate: 40 mg Depo-Medrol + 1-2 mL 0.25% bupivacaine
* Infra-articular inferior pole
Trigger Point Injections
Medications to order:
Lidocaine 0.5%
Procedure:
* Injectate: 10 mL lidocaine (1 mL per site)
* Check notes, sometimes she does depo in old people who can’t get other procedures
Trochanteric Bursa Injection
Medications to order:
Lidocaine 0.5% (50 mL)
Bupivacaine 0.25% (10 mL)
Depo-Medrol 40 mg (1 mL)
Procedure:
* Supine
* Injectable: 40 mg Depo-Medrol + 2-3 mL 0.25% bupivacaine
== Dr. Richard Gao ==
- For procedure notes, prefers copy forward of prior notes and embed procedure note
Lumbar Medial Branch Blocks
Medications to Order:
0.5% lidocaine (50 mL)
0.25% bupivacaine (10 mL)
Depo-Medrol 40 mg/mL (unilateral) vs. 80mg/mL (bilateral)
Procedure:
* 22 gauge 3.5 inch spinal needle (bent tip)
* Injectate: 1 mL at each level of mixture 2mL 0.25% bupivacaine + 1mL depo-medrol
* AP-only
Cervical Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Decadron 10mg/mL vial
Omnipaque 180
Procedure:
* Contralateral oblique view
* Loss of resistance with omnipaque in 3 cc syringe
Lumbar Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (80mg total)
Omnipaque 180
Procedure:
* 20g tuohy needle
* Advance in contralateral oblique view with loss of resistance to omnipaque in 3 cc syringe
* Inject mixture of 3ml 0.5% lidocaine, 2ml 40mg/mL depo-medrol or 4ml 0.5% lido and 1ml 80mg/ml depo
Lumbar Radiofrequency Ablation:  
Medications to Order:
Lidocaine 0.5% (50 mL)  
Lidocaine 2% (5 mL)  
Procedure:
* 18g radiofrequency needle
* Complete sensory and motor testing
* Inject each level with 1ml 2% lidocaine prior to RFA
Lumbar Transforaminal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg (occasionally 20 mg for 2 level)
Procedure:
* Pointer initially in AP at lateral inferior edge of transverse process
* Transition from AP to oblique with pointer in place
* Bent 22-gauge 3.5/5 inch spinal needle
* Injectate: 5-10 mg dexamethasone + 1-1.5 mL 0.5% lidocaine per level
Trigger Point Injections
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (1 mL vial) (occasionally)
Procedure:
* Ask if lidocaine-only (usually first TPIs) or lidocaine + steroid
* Injectate: 1 mL Depo-Medrol 40 mg/mL + Lidocaine 0.5% (50 mL)
Sacroiliac Joint Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* Medial to lateral approach (intra-articular)
* #22-gauge 3-½ inch spinal needles (inferior pole)
* 40 mg Depo-Medrol and 3 mL 0.25% bupivacaine into each joint
Cervical Medial Branch Block
Medications to order:
Lidocaine 0.5% (50 mL)
Dexamethasone 10 mg/mL
Bupivacaine 0.25% (10 mL)
Procedure:
* Patient lateral
* Injectate (for 3 levels): 1ml of a 3ml mix of 10 mg dexamethasone + 2 mL 0.25% bupivacaine
* 3.5 inch 22-gauge spinal needle with bent tip (only 1 needle and re-direct)
Caudal Epidural Steroid Injection
Medications to Order:
Lidocaine 0.5% (50 mL)
Omnipaque 180
Depo-Medrol 40 mg/mL
Procedure:
* #22 gauge spinal needle
* Inserts midline  
* Confirmation with contrast in lateral + AP views  
* Inject 80 mg methylprednisolone with 6 mL 0.5% lidocaine
Baclofen Single Shot (with Fluoroscopy)
Medications to Order:
Baclofen 50 to 75 mcg/ml  
Confirm dose with attending
Procedure:
* Spinal kit with 25 G Whitacre
Genicular Nerve Block:  
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate: 40 mg Depo-Medrol + 8 mL 0.25% bupi; 3 ml at each of the 3 levels (per knee)
Knee Intra-Articular Steroid
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL (5 mL vial)
Bupivacaine 0.25% (10 mL)
Procedure:
* #22 spinal needle
* Injectate: 6 mL 0.25% bupivacaine + 80 mg Depo-Medrol
* Fluoroscopy with 3.5 inch spinal needle
Shoulder Injection with Fluoroscopy
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL  
Bupivacaine 0.25% (10 mL)
Procedure (Glenohumeral):
* Lateral to medial approach  
* #22-gauge 3-½ inch spinal needle
* Injectate: 40 mg Depo-medrol + 5 mL 0.25% bupivacaine  
Procedure (Acromioclavicular):
* #25-gauge 1-½ inch local needle
* Injectate: 40 mg Depo-medrol + 1 mL 0.25% bupivacaine  
Sphenopalatine Ganglion Block
Medications to Order:
Bupivacaine 0.5%  
Procedure:
* Cotton swab  
TAP Block (Ultrasound)
Medications to Order:
Lidocaine 0.5% (50 mL)
Depo-Medrol 40 mg/mL
Bupivacaine 0.25% (10 mL)
Procedure:
* Injectate: 9 mL 0.25% bupivacaine + 40 mg Depo-Medrol (per side)
* Needle insertion (Pajunk) from medial to lateral
Suprascapular Nerve Block
Medications to Order:
Depo-Medrol 40 mg/1mL vial
Bupivacaine 0.25% (10 mL)
Lidocaine 0.5%
Procedure:
* 25g 3.5 inch spinal needle
* Ipsilateral oblique view with cephalad tilt to target suprascapular notch; confirm depth with lateral view
* Inject mixture of 1cc depo-medrol with 3cc bupivacaine<br />
== Dr. Arti Ori ==
Occipital Nerve Block
Medications to order:
Bupi 0.5% (10 mL if bilateral)
Depo-Medrol 40 mg
Procedure: 3cc to greater, 2cc to lesser, can draw all up in one syringe with 25g needle
Cervical Medial Branch Blocks
Medications to Order:
<nowiki>***</nowiki>Lidocaine 0.5% (50 mL)
<nowiki>***</nowiki>Lidocaine 2% (5 mL)
<nowiki>***</nowiki>
Knee Intra-Articular Steroid with Fluoroscopy
Medications to Order:
Lidocaine 0.5% (50 mL) > draw up 10cc
Bupivacaine 0.25% (10 mL) > draw up 5 cc per side
40 mg Depo-Medrol mixed in bupi
Find divet under kneecap (lateral/caudal) and inject lido all the way to the end of the needle. Shot, see where it is, try to get it in the center of the joint.
Sacroiliac Joint Intra-articular Injection
Medications to Order:
Lidocaine 0.5% (50 mL) or 1% (30 mL)
Depo-Medrol 40 mg
Bupivacaine 0.25% 30 mL
Procedure:
- Injectate: 3 mL 0.25% bupi + 40 Depo-Medrol (3 mL total)
Oblique 20 deg contralateral to the side, hold finder needle just above gluteal cleft and a bit lateral.
Trigger Point Injections
Medications to order:
Lidocaine 0.5%
Procedure:
* Injectate: 10 mL lidocaine (1 mL per site)
GTB (Greater trochanteric bursa):
* Coming in laterally at greater trochanter
* Lido in 10cc
* 40 depo + 3 of 0.25 bupi in 5cc
Genicular nerve block Injections
* 3 sites, superomedial, inferomedial, superolateral, landing on bone at each site
* Insert needles in AP but take a lateral image before injection
* Draw up 10cc bupi with 40 depo, do 3cc at each sites
== Dr. Reilly ==
For synvisc, aspirate joint fluid before injecting

Latest revision as of 11:13, 2 August 2023

Top contributors: Olivia Sutton

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