Click to edit Master title style Ouch!!! That’s ... Conference Documents-Images/H… · Stellate Ganglion Block 31 •A type of sympathetic nerve block performed to determine if

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Click to edit Master title style

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Ouch!!! That’s Better: Interventional Pain Options

K a thy A . B au le D N P, R N , A P N -A C N S-B C, C C R N , C N R N


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Conflict of Interest Disclosure

• Author’s conflicts of interest:• Dr. Baule has no conflict of interest


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Objective 1:

At the conclusion of the presentation, the learner will be able to provide examples of treatment interventions for cervical, thoracic, and lumbar pain.

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Objective 2:

After participating in the presentation, the participant will be able to provide examples of treatment options for cancer pain.


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Objective 3:

At the conclusion of the presentation, the learner will be able to identify two intraoperative procedures for pain control.


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Types of Spinal Pain

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•Cervical

•Thoracic

•Lumbar

Image from Disabled World; Retrieved from https://disabled-

world.com/disability/types/spinal/spine-picture.php

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Spinal Pain Interventions

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• Epidural injection

• Selective nerve root block

• Radiofrequency (RF) nerve ablation

• Sacroiliac joint (SI) joint injection


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Image from Spine Center of the Emerald Coast; Retrieved from

http://www.emeraldcoastspine.com/transforaminalinjection.html


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SI Injection

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Image from Los

Angeles Minimally

Invasive Spine

Institute; Retrieved

from

https://www.lamisinstit

ute.com/procedures/sp

inal-

injections/sacroiliac-

joint-injection-los-

angeles

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RACZ Caudal Neurolysis

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Image from Shepherd Pain Institute;

Retrieved from

http://www.shepherdpaininstitute.org/tre

atment/spine/RACZ


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Facet Injection

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Image from University of Rochester Medical

College; Retrieved from

https://www.urmc.rochester.edu/imaging/patie

nts/procedures/joint-injection.aspx


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RF Ablation

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Image from BoneandSpine.com; Retrieved from https://boneandspine.com/radiofrequency-neurotomy/

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The Spine & Pain Institute of New York; Retrieved from

https://www.youtube.com/watch?v=6m133lQsJBE


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Treating Cancer Pain

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Cancer Pain Treatments

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• Head, neck and cervical

spine

• Maxillary and mandibular

nerve blocks


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Cancer Treatment, Cont.

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• Abdominal cancer

• Celiac plexus

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More Cancer Options

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• Splanchnic nerve

• Associated pelvic and perineal

visceral pain


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Treatment of Metastatic Spine Disease

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• Stereotactic body radiation therapy

(SBRT)

• Percutaneous tumor ablation


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Nerve Blocks


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Three Step Process for Nerve Blocks

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•Diagnostic blocks

•Prognostic blocks

•Therapeutic blocks

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Types of Nerve Blocks

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• Trigeminal

• Sphenopalatine ganglion

• Glossopharyngeal

• Occipital

• Vagal

• Cervical plexus


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Trigeminal

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Neuroablation

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Image retrieved from

https://www.moddb.com/m

embers/snehadiva82/video

s/radiofrequency-

neuroablation

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Occipital Nerve Block

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Other Nerve Blocks

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Sympathetic Nerve Block

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A sympathetic nerve block is one

that is performed to determine if there is damage to the sympathetic

nerve chain.

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Stellate Ganglion Block

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• A type of sympathetic nerve block

performed to determine if there isdamage to the sympathetic nerve

chain supplying the head, neck,

chest, or arms and if it is the

source of pain in those areas.


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Stellate Ganglion Block

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Genicular Nerve Block

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Genicular RF

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Surgical Interventions


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Surgical Interventions

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• Intrathecal Pain Delivery System

• Spinal Cord Stimulator

• Kyphoplasty/ vertebroplasty / sacroplasty

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Reasons for Intrathecal Pumps

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Image retrieved from www.ncbi.nlm.nlb.ov./pmc


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Is The Pump For You?

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• Must go through complex trial to see if

treatment decreases pain/spasticity

• Single injection through lumbar puncture

• Multiple injections over the course ofdays

• Continuous trial-catheter placed incorrect area of the spine connected to

external pump


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Spinal Cord Stimulator

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But Wait

There’s More!!!


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Minimally Invasive Spine Procedures

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• MILD®

• Endoscopic foraminotomy

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MILD®

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Endoscopic Foraminotomy

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Images from Atlantic Spine Center Video, Retrieved from https://www.youtube.com/watch?v=v1RwKwRDNPM


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Kyphoplasty

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Image from DrOsborn.com; Retrieved from

https://www.drbrettosborn.com/neurological/kyphoplasty

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Trauma

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• Rib fixations

• Bupivacaine liposomal

injection suspension

(EXPAREL®) – slow release

local anesthetic

• OnQ® Pump


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OnQ® Pump

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Image from Halyard Health Products;

Retrieved from

https://products.halyardhealth.com/acute-

pain/ambulatory-pain-pumps/variable-rate-

pumps/on-q-pump-with-ondemand.html


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Transversus Abdominis Plane (TAP) Block

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• Places local anesthetic in the

lateral abdominal wall in a planebetween the internal oblique and

the transvers abdominis muscles

• Can block many of the abdominalnerves as they pass to the

abdominal structures

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TAP Block

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Wrap Up

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• Explained interventions for spinal pain

• Provided an overview of interventions for

cancer pain

• Provided several intraoperativeprocedures for pain control


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Thank You for Your Attention

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Questions

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Dr. Nick Riviera; Retrieved from

http://simpsons.wikia.com/wiki/Nick_Riviera