September 16th, 2010

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Proper pain management notes

I decided to call the doctor who did the "good" procedure where I wasn't being tortured with unnecessary pain. I'm writing down the basic points as best I can remember them

Conversation with Dr. Lo:

He's had local anesthetic resistant patients before so I'm not uncommon, maybe 1-2 per cent.

He says the local injection needle is shorter than the Tuohy needle (1 1/4 inches vs 3 1/2 inches), so what he does is send some more numbing agent down the Tuohy needle when he gets beyond the 1 1/4 inch point during the procedure.

Also, he waits a few minutes for such patients rather than going right in after the local.

He finds that IV meds help the local anesthetic's effectiveness, even a mild dose. He used 2 mg versed before local, and a small dose of fentanyl just before the procedure injection. (He couldn't remember how much but I suspect it was similar to the versed because I wasn't that spacey. I've had fentanyl for procedures before. Though frankly, if I'm not numb it doesn't do much to mask that--as in my angiograms.)

He was looking for a longer needle for the local injection because that also helps numb the path to the cortisone injection site. (Unfortunately they didn't have one there but he managed without it.)

Regarding how many injections per year, he says there is no real rationale for only 3. No long term studies have been done regarding safe amount, but since the amount of steroid used in an injection is so small compared to the amounts people with asthma or arthritis take, there's no real reason to limit injections to three per year. He believes 2-6 per year is safe and he generally does 3-4, spaced apart by a few months. He says he'll only go in within a few weeks if the patient only had partial relief and still has pain in one area.

He suggested that the Santa Theresa Kaiser is more oriented to intervention and they use IV meds in this procedure, he knows the guys in that department and suspects I'd be better served there. Too bad it's a fair distance from me...but it may be worth it if I can't get satisfactory service locally.
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