Index

A Anisotropy, 447 Abdominal pain. See Nerve blocks Ankle injection. See Tibiotalar injection Abdominal wall blocks and neurolysis Ansa subclavia, 538 accuracy, 489 Anticoagulant therapy, 53–55 analgesia, 495 Antithrombotic and antiplatelet therapy chronic, 489 epidural hematoma, 53 diagnostic and therapeutics, 495 epidural hematomas, 53 ilioinguinal (see Ilioinguinal and iliohypogastric nerves block) guidelines, 53 paravertebral (see Paravertebral nerve block) interventional technique guidelines, 56 procedures, 489 risk/benefit ratio, 53 rectus sheath (see Rectus sheath block) surgical interventions, 53 TAP block (see Transversus abdominal plane (TAP) block) survey, 53 Accountable interventional pain management, 3 thrombotic risks with discontinuation, 53, 54 epidural injections utilization, 5, 12 Arteria radicularis magna (ARM), 201 facet joint interventions, 6, 10 Arthritis, 370 Medicare beneficiaries, epidural injections, 6, 8 botulinum toxin, 630–631 policies, 6 As low as reasonably achievable (ALARA), 118, 121 sacroiliac joint interventions, 6, 8 Atlanto-axial joint Acetylcholinesterases (AChE), 612 anatomy, 415–417 Acromioclavicular joint injection, 637, 638 C1-C2 injection, 414 Acute cervical disc extrusion, 102 cervicogenic headache, 413, 414 Ambulatory surgery centers (ASCs) diagnosis, 414–415 anesthetic requirements, 37 fluoroscopy, 418, 419 anesthetic risk and evaluation, 38 inflammatory disorders, 414 discharge/disposition, 38–39 pathophysiology, 413, 414 guidelines, medical record, 37 physical examination, 415 history and physical examination, 36 side effects, 420 intra- and postoperative documentation requirements, 38 TON, 416 physician’s history, 36 ultrasound, 419, 420 physician’s physical examination, 37 vertebral artery, 416, 417 preoperative Medical Record Requirements, 37 Atlanto-occipital joint procedural documentation, 38 fluoroscopy, 417 requirements, 36 ultrasound, 417–420 American Society of Interventional Pain Physicians (ASIPP) See also Atlanto-axial joint guidelines, 382 Automated percutaneous lumbar discectomy, 309, 312, 313, American Society of Regional Anesthesia and Pain Medicine (ASRA) 323–325 guidelines, 365, 382 Axillary nerve anatomy, 500 Anatomy of the spine Axillary nerve block, 499, 500 injectionist, 63 ligaments (see Ligaments of spine) planes B bony elements, 70 Biacuplasty, 302–306 column (see Spinal column) Biceps tendon sheath fluoroscopic see( Fluoroscopic anatomy, spine) anatomy, 619 and nomenclature, 63 color Doppler, 619 position, 63 diagnosis, 619 spondylolisthesis, 71 inflammation, pain/tenderness, 618 spondylolysis, 70 landmark-based and ultrasound-guided techniques, 619 Anesthetic discography, 273 pathophysiology, 618–619 lumbar functional, 276 ultrasound, 619–620

© Springer International Publishing AG 2018 697 L. Manchikanti et al. (eds.), Essentials of Interventional Techniques in Managing Chronic Pain, https://doi.org/10.1007/978-3-319-60361-2 698 Index

Bleeding risk C antithrombotic and antiplatelet therapy, 53 Cadaver dissection, 554 atherothrombotic events, 54 Cadaver study, 554 cerebral and cardiovascular events, 54 Calcitonin gene-related peptide (CGRP), 612 epidural hematoma, 55 Cancer thromboembolic phenomenon, 54 sacral fractures, 432 Blind Intercostal Nerve Blocks, 483–484 vertebral fractures, 432 Bony elements Carpal tunnel injection coronal cadaver section, 71 corticosteroid, 641 load-bearing capacity, 71 CTS, 641 lumbar vertebral motion segment, 70 flexor carpi radialis and palmaris tendon, 641 midline spinous processes, 71 glucocorticoid, 641 pars interarticularis, lumbar vertical body, 72 indications and diagnosis, 641 prototypical vertebra, 70 intravascular placement, 641 red bone marrow, 70 pathophysiology, 641 spondylolysis precautions, 641–642 and fluoroscopy, 73 randomized controlled trials, 641 and spondylolisthesis, 72 ultrasound, 642 transverse processes, 70 ultrasound-guided, 641 vertical C-arm, L4-L5, 70 Carpal tunnel syndrome (CTS), 502 Botulinum toxin Caudal epidural adhesiolysis, 255–258, 261, arthritis, 630–631 264, 265 blockade, acetylcholine release, 630 Caudal epidural injections, 174, 178–182 capsaicin, 630 Caudocranial angulations, 544 cervical dystonia, 632 Celiac plexus blocks history, 629 anatomy, 596–600 injection, 629 bent-tip needle, 603, 604 lifesaving treatment modality, 632 cardiac and hypogastric plexuses, 595 mechanism of analgesia, 630 celiac ganglia, 602 MFPS, 631 chronic abdominal pain, 595 migraine, 630 indications, 596 neuromuscular disorders, 629 neurolysis, 603–605 neuropathic pain, 630 pancreatic cancer, 596 pain modulation, 630 percutaneous approach, 595 pelvic pain and dysfunctional defecation, 632 precautions, 605 preparation, 629 retrocrural approach, 600–602 treatment, chronic pain, 630 side effects, 605, 606 trigeminal neuralgia, 631 splanchnic nerve blocks, 603 Brachial plexus blocks, 497–499 transdiscal approach, 603 Brilinta®, 366 Centers for Medicare and Medicaid Services Buerger’s disease, 535 (CMS), 301 Bursa Central nervous system injection, 543 iliopsoas (IP) Certified Registered Nurse Anesthetists anatomy, 621, 622 (CRNAs), 41 diagnosis, 621, 622 Cervical and thoracic sympathetic blocks evidence based, 621 analgesia, 531 hip pain, 622 CRPS, 531, 533 osteoarthritis, 622 diagnosis, 535 pathophysiology, 621, 622 ganglion block, 534 tendon and hip joint capsule, 621 history, 531 ultrasound-guided injection technique, 621–623 hyperhidrosis, 535 precautions, 625 IASP criteria set, 535 subacromial-subdeltoid pathophysiology, 532–533 diagnosis, 618 peripheral neuropathic pain, 534 evidence based, 617–618 stellate ganglion block, 531 location, 618 superior cervical ganglion, 536 pain, upper extremity, 617 Cervical discogenic pain, 209, 210, 212 pathophysiology, 617 Cervical discography shoulder disorders, 617 anterior approach, 282–286 supraspinatus tendon, 618 anterolateral, 290, 291 ultrasound, 619 anterolateral approach, 282, 286 ultrasound-guided injection technique, 618 assessment, pain relief, 273 Bursitis CT-discograms, 292 PAB, 623, 624 CT imaging, 291 RB, 624, 625 diagnostic accuracy, 277 Index 699

disc injection treatment, 408, 409 completion, 290 typical cervical levels, 406, 407 high discometric pressure, 286 vascular structures, 396, 397 pain level, 286 Cervical interlaminar epidural injection, 218–222 pain quality, 290 axial diagram, 222 saline or contrast, 286 complications, 236 discogram, 292 dural puncture, 222 evaluation, 273 epidurographic patterns, 222 low back pain, 274 fluoroscopic imaging, 220 rationale, 276 indications, 212 validity and functions, 273 intravascular entry, 228 spine status post disc injection, 292 midline approach, 222, 223 Cervical dystonia, 632 paramedian approach, 220 Cervical epidural injections paramedian position, 222 anatomy resistance technique, 220 C2 and C3 spinal nerve, 218 subdural filling patterns, 228 cervical spine, 212 subdural placement, 225 dorsal and ventral rootlets, 217 Cervical radicular pain, 209, 210 dural root sleeve, 212 Cervical radiofrequency neurotomy, 405, 406 epidural space, 215 Cervical spinal stenosis, 210, 212, 215 ligaments, 214 Cervical sympathetic ganglia, 536, 538 ligamentum flavum, 215 Cervical sympathetic trunk, 536 typical cervical vertebrae, 212 Cervical transforaminal epidural injections, 212 venous system, 218 axial view, 231 evidence base, 210–212 complications, 236 indications, 212 critical anatomic considerations, 229–231 interlaminar and transforaminal approach, 212 fluoroscopy, 228 pathophysiology level IV evidence, 212 cervical radiculopathies, 210 step-by-step approach, 234 corticosteroids and local anesthetics, 210 Cervical transforaminal injections, 209 disc displacement, 210 Cervicogenic headache, 413–415 hard protrusions, 210 Cervicothoracic, 536 myelopathy, 210 Chemical neurolysis, 455 post cervical laminectomy syndrome, 210 Chemical neurolytic block, 565 radicular pain, 210 Chemonucleolysis, 309, 313 precautions, 236, 237 Chest wall blocks and neurolysis. See Intercostal nerve blocks resistance technique, 209 Chronic abdominal pain, 595 side effects and complications, 235, 236 Chronic disorders, 611 technical aspects Chronic low back pain. See Percutaneous adhesiolysis extra-epidural placement, 222–228 Chronic pain extraneural placement of needle, 235 classification and prevalence, 24 interlaminar epidural injections, 218–222 intrathecal analgesics, 678 safety considerations, 231–233 NMDA receptor antagonists, 22 technique, 233–235 opioids, 671 transforaminal epidural injections, 228–231 pain signaling (see Pain signaling) Cervical facet joint nerve blocks, 390, 391 psychological assessment, 676 Cervical facet joint pain and spasticity, 671, 672 C7 transverse process, 407, 408 terminology, 15 controlled diagnostic blocks, 389, 390 therapy, 676 diagnosis, 389 Chronic perineal pain, 581 false-positive rate, 387 Chronic shoulder pain false-positive rates, 390 block, suprascapular nerve (see Suprascapular nerve block) features, 392 intraarticular corticosteroids, 471 indications, 392 muscles and shoulder joint, 471 innervation, 392–396 treatment options, 471 intra-articular (see Intra-articular cervical facet joint injections) Classic approach, 576 neck pain, 387 Classic superior hypogastric block, 576, 577 nerve blocks, 390, 391 Cluster headaches, 521 pathophysiology, 388, 389 Cochrane review, 552 pulsed mode radiofrequency, 405 Common peroneal nerve (CPN) block, 513 radiofrequency neurotomy, 405, 406 Complex regional pain syndrome (CRPS), 531, 532, 659, 661, 683 RCTs, 389 Compliance and documentation. See Documentation side effects, 409 Computed Tomography (CT), 90 structure, 392–394 Conscious sedation, 42, 43, 45, 46 third occipital nerve, 408 Continuous intrathecal infusion, 680 700 Index

Controlled clinical trials, 534 anesthetic, 273 Conventional radiofrequency (CRF), 456 annular pathology, 273 Corticosteroids antiplatelet agents, 297 Addisonian crisis, 30 antithrombotics and anticoagulants, 296 anti-inflammatory and immune-modulating properties, 29 apixaban, 297 cellular mechanism, glucocorticoid, 31 aspirin and NSAIDs, 297 compounded steroids, 31 cervical (see Cervical discography) cortisol inhibition, 30 clefts and radial tears, 274 cytoplasmic receptor, 30 CT, 274, 275 effects, glucocorticoids, 31 CT-myelography, 274 fungal meningitis, 31 dabigatran (Pradaxa®), 296 glucocorticoids, 30, 31 diagnostic validity, 274 hepatic metabolism, 30 disc stimulation, 273 injectable depot, 30 disc-related pain, 275 long-acting steroids, potency and particle size, 31 fluoroscopic visualization, 281 methylprednisolone, 30 imaging tool, 273 spinal infarction, 30 indications, 277 steroid hormones, 29 injuries, disc, 274 synthetic glucocorticoids, 30 internal disc disruption (IDD), 275 upper extremity injection, 637, 641 intervertebral disc, 277 C7 transverse process, 407 intervertebral disc aging and degeneration, 274 Cryoablation, 591, 592 intervertebral disc protrusion/herniation, 274 Cubital tunnel syndrome, 504 intervertebral discs, 277 level of evidence, 276, 277 lumbar disc, 273 D lumbar regions (see Lumbar discography) Deep brain stimulation (DBS), 659, 683 lumbar, late 1940s and early 1950s, 273 Degenerative cervical spine disease MRI, 274 central cervical spinal canal stenosis, 99 needles, 281 chronic disc/osteophyte complex, 99 pain generators, 275 disc extrusion, 98–99 precautions, 296 disc protrusion, 98 procedure, 273 facet joint degenerative disease, 99 provocation, 273, 274 narrowed neural foramen, 99–100 rivaroxaban, 296 Degenerative lumbosacral spine side effects and complications, 294–296 central canal stenosis, 93–95 spinal column, 277 degenerative sacroiliac (SI) joint disease, 95–96 thoracic (see Thoracic discography) facet disease, 93 validity, 276 inflammatory reaction to intervertebral disc disease, 92–93 vertebral column, 277 intervertebral disc disease, 91, 92 warfarin therapy, 296 neural foraminal narrowing, 95 DiscTRODE, 302 postoperative spine, 96 Documentation Degenerative thoracic spine ASCs (see Ambulatory Surgical Centers (ASCs)) costochondral joint abnormalities, 97 billing and coding, 35 disc protrusion, 96–97 clinical data, 35 kyphosis, 97 developments, 35 Dekompressor, 309, 313, 314, 320, 327, 328 medical services, 35 De Quervain’s Tenosynovitis outpatient (see Hospital outpatient department) abductor pollicis longus (APL), 620 procedural, 38 anatomy, 620 requirements diagnosis, 620 history and physical, 35, 36 extensor pollicis brevis (EPB) tendons, 620 indications and medical necessity, 36 history, 620 procedural, 36 pathophysiology, 620 Dorsal root ganglion (DRG), 350, 370 ultrasound, 620–621 Double-needle system, 559 Diagnostic tests, 535 Dry needling, 611, 613 Digital subtraction angiography (DSA), 201, 228 Disc bulging, 311 Disc degeneration, 370 E Disc herniations, 309, 312–315, 334 Effient®, 366 Disc protrusions, 311 Elbow injection Discogenic low back pain, 301, 306, 307 indications and diagnosis, 640 Discogenic pain, 143, 145 interventional techniques, 640 Discography pain, 639 abnormal psychometrics, 275 pathophysiology, 639 anatomy steroid, 639 intervertebral disc, 279 Elbow joint injection vertebral column, 278 landmark-based technique, 640 Index 701

Electrostimulation, 565 Fluoroscopy Enthesis, 617 ALARA, 121 precautions, 625 analogue to digital converter, 116 Epidural adhesiolysis, 263 anatomy of spine, 109 Epidural fibrosis, 241–243, 245 cathode ray tube, 109, 110 Epidural injections, 241, 243, 245, 269 clinical applications, 120, 121 collimation, 114, 115 configuration, 116, 117 F glenohumeral joint, 638 Facet joint nerves, 380 glenohumeral joint injection, 639 Facial pain syndrome, 519 high-velocity electrons, 110 Failed back surgery syndrome image intensifier system, 114 (FBSS), 659, 661, 662 imaging chain, 112, 113 False-negative rate, 353 interventional pain management, 109, 114, 116, False-positive rates, 353 119, 121 Femoral tibial injection needle placement, 117, 120 diagnosis, 649 optical coupling, 115 evidence base, 649 procedural characteristics, 120 fluoroscopic guidance, 650 radiation exposure, 120, 121 fluoroscopy, 650 radiation safety, 117–120 history, 649 table and pad materials, 116 interventional, 650 upper extremity injection, 635 osteoarthritis, 649 x-ray generator, 112 pain, knee joint, 649 x-ray tube, 112, 113 pathophysiology, 649 Fungal Meningitis, 31 preparation, 650 side effects and complications, 651 stabilization, 650 G synovial joint, 650 Ganglion impar block (GIB) tendons, 650 anatomy, 582–585 ultrasound, 650–651 chronic perineal pain, 581 ultrasound guidance, 651 cryoablation, 591, 592 Femoroacetabular injection direct approach, 592 anterior approach, 648 fluoroscopy, 582, 586 ultrasound guidance, 648 indications, 582 Femoroacetabular joint injection magnetic resonance neurography, 591 accuracy, 646 modified needle-inside-needle technique, 586, 587 acetabulum, 646 needle positioning, 589–591 anesthetics, 647 needle-in-needle technique, 593 corticosteroid, 646 neurolysis, 588–589 diagnosis, 646 paramedian approach, 592 fluoroscopy, 647 pathophysiology, 581 intra-articular interventions, 645 pelvic pain, 581 joint capsule, 646 perineal pain, 581 localization, 645 precautions, 593 muscle, 646 rectal pain, 581 neurovasculature, 646–647 SCJ, 581 pathophysiology, 645 side effects and complications, 593 preparation, 647 thermocoagulation, 589, 592 procedure, 647 trans-sacral technique, 586, 588 proximal femur, pelvis, 646 types of needle, 584, 585 side effects and complications, 647–648 Ganglion of Walther, 581, 582 sterile gauze, 647 Gauci’s technique, 568–569 ultrasound, 645, 647 Genitofemoral nerve (GFN), 509 viscosupplementation, 646 Genitofemoral nerve blocks, 509, 510 Fluoroscopic anatomy, spine Genitofemoral neuralgia, 569 dorsal soft tissues and lamina, 68 Glenohumeral joint higher-density regions, 68 anterior approach, 639 L4 spinous process, 68 articulation humerus and glenoid fossa, 638 L5 spinous process, 68 fluoroscopicy, 639 overlapping tissue densities, 68 indications, 638 pedicle, 68 injection, 638 two-dimensional, 68 nonsteroidal anti-inflammatory drugs, 638 variable density, 68 office-based procedure, 638 x-ray beam, 68 posterior approach, 639 Fluoroscopically guided intercostal nerve Blocks, 485 ultrasound, 639 702 Index

Glenohumeral joint injection early and late complications, 679 anterior approach, 639 electronic module, 673 fluoroscopic-guided, 639 Flowonix Prometra programmable, 674 Glucocorticoid injection, 636 implantation, 676 Glucocorticoids, 30, 31 Medallion system, 673 Glycerol neurolysis, 455 Medtronic SynchroMed, 673, 675 Granulomas nonprogrammable, 673, 675 side effects and complications, 679 programmable, 673, 675 Greater occipital nerve (GON) block, 465–469 Prometra, 673 spasticity, 673 SynchroMed II, 673 H Infectious diseases, 104–106 Headache disorders, 465, 466 Inferior hypogastric plexus block, 573, 574, 577 Hip injection. See Femoroacetabular joint injection Infraneural approach, 201–204 Hospital outpatient departments In-Office Documentation, 39 history and physical examination, 39 “In-plane” approach, 447 informed consent, 39 Integrated hypothesis, 612 in-office document, 39 Intercostal Chemical Neurolysis, 486 intra- and postoperative documentation, 39 Intercostal nerve blocks monitoring, 39 anatomy, 482, 483 procedural documentation, 39 blind intercostal nerve blocks, 483–484 Hydrodiscectomy, 313, 314, 328–332 chemical neurolysis, 486 Hypertrophic ligamentum flavum, 425, 426 chest wall pain, 481 Hypogastric sympathetic plexus block chronic pain, 481 anatomy, 574–576 cryoablation, 482 diagnosis, 574 diagnosis, 482 evidence base, 574 fluoroscopic/ ultrasound guidance, 482 history, 573 fluoroscopically guided procedure, 485 indications, 574 fluoroscopy, 486 neurolysis, 574 history, 481 pathophysiology, 573–574 medications, 484 pelvic pain, 573 minimally invasive coronary artery bypass grafting, 482 percutaneous neurolysis, 573 myriad of conditions, 481 technical aspects pathophysiology, 481 anterior ultrasound approach, 578 pectoral nerve blocks, 482 classic superior hypogastric block, 576–577 precautions, 486 transdiscal superior hypogastric block, 577 radiofrequency lesioning, 485 transsacral inferior hypogastric block, 577–578 relationship, 484 side effects and complications, 486, 487 ultrasound approach, 484, 485 I ultrasound guidance, 482 Ilioinguinal and iliohypogastric nerves block Interdigital neuritis, 514, 515 abdominal and pelvic wall pain, 494 Interlaminar approach deep circumflex iliac artery courses, 494 epidural filling patterns, 157–160 diagnosis, 494 fluoroscopy, 153 lower ventral, 494 Tuohy needles, 153, 156 neuralgia after hernia repair, 494 Internal annular disruption (IAD) palpation, 494 approaches, 301 precautions, 495 heat, 301 simulated needle path, 495 IDD, 301 T12 and L1, lumbar plexus, 494 intervertebral disc, 307 techniques, 494, 495 Internal disc disruption (IDD), 301 ultrasound, 494 International Association for the Study of Pain Committee, 532 Image intensifier system, 114 International Spine Intervention Society (ISIS) guidelines, 382 Imaging modalities Interstitial cystitis (IC), 686, 690, 691 CT, 90 Interventional pain management MRI, 90, 91 accountable, 3 myelography, 91 coverage policies, 7 myelopathy, 107 definition, 4 nuclear medicine, 90 development plain X-Rays and fluoroscopy, 89 board certification, 4 Implantable pump organizations, 4 advantages, 673 specialty designation, 4 catheter and targeted site, 672 emerging specialty, 6 Codeman MedStream programmable, 674 history, 3, 4 drug delivery, 673 neural blockade, 3 Index 703

physician fee schedule methodology, 7 Knee joint injection. See Femoral tibal injection rapid advances, 6 Kuntz fibers, 541 rapid growth, 7 Kyphoplasty. See Vertebroplasty regional analgesia, 3 value-based practice, 3 Interventional techniques, 35, 53 L antithrombotic (see Antithrombotic and antiplatelet therapy) Lateral (Reid’s) Approach, 556–559 documentation (see Documentation) Lateral femoral cutaneous nerve (LFCN), 510, 511 Intervertebral foramina (IVF), 214 L5 Dorsal Ramus Blocks, 362 Intra- and Postoperative Documentation, 39 Lesser occipital nerve (LON) block, 464–469 Intra-articular cervical facet joint injections Ligaments of spine lateral approach, 399, 400, 403–405 anterior, 71 medial branches, 401, 402 blood supply posterior approach, 396–399, 402, 403 anterior spinal artery, 85 Intra-articular facet injections, 360 arterial circulation, 85 Intra-articular Thoracic Facet Joint Injections, 378–380 arterial supply, 84 Intradiscal biacuplasty (IDB), 306 C8 radicular artery, 88 Intradiscal electrothermal therapy (IDET) foramina, 85 conductive heating, 302 interventional pain, 85 discogenic low back pain, 302 nerves and blood vessels, intervertebral foramen, 88 false-negative error, 302 posterior spinal arteries, 85 nucleus and annulus, 302 spinal cord, 85, 86 RCTs, 302 spinal cord with nerve roots, 87 technique, 302 and bone elements, 74 VAS score, 302 cervical, 73, 75, 76 Intrathecal drug delivery CSF, 81 abdominal incision, 677–678 dorsal, 72 analgesic agents, 671 epidural injection procedures, 83 anatomy, lumbar spine, 672 epidural space, 81 baclofen, 678 excessive sensory-motor block, 83 chronic pain, 671 fibrous bands, 82 cocainization, spinal cord, 671 intrathecal injection, 83 doses, 678 ligamentum flavum, 72 early and late complications after pump insertion, 679 loss-of-resistance technique, 72 epidural block, 671 lumbar, 76 evidence-guided drug selection algorithms, 680 myelographic and subarachnoid filling patterns, 83 implantable pump, 671 nerve roots, 80 implantation, 674 posterior longitudinal, 71 indications, 672 sacrum, 71, 76 morphine and Prialt, 678 supraspinous, 72 noncancer pain patients, 680 thoracic vertebrae, 76 oral or transdermal opioids, 679 vertebral canal and epidural space, 82 2012 PACC recommendations, 678 Local anesthetic blockade, 534 pain and spasticity, 678 Local anesthetics peripheral and systemic penetration, 671 absorption, 27 permanent implant, 676, 677 action and side effects, 28 placement, 677 amine group, 27 precautions, 679 aminoester/aminoamide structures, 27 psychological evaluation, 674 cocaine, 27 pumps, 673 cytochrome P450 CYP2D6, 28 recommendations, 678 effects, 27 side effects and complications, 678–679 injection and local vascularity, 27 spinal and epidural anesthesia, 671 intravascular injection, 28 spinal medications, 671 itraconazole inhibition, 28 systemic opiates, 671 lipophilicity, 27 therapy, 671 liposomal bupivacaine, 28 trialing, 676, 680 management, systemic toxicity, 29 tunneled catheter, 674 molecules, 27 Intravenous sedation, 43–45 risks, 28–29 ropivacaine, 28 selection, 29 K sodium bicarbonate, 27 Kambin’s triangle approach systemic toxicity, 29 oblique approach, 167, 168 toxicity, 29 posterior approach, 167 types, 28 posterolateral approach, 166 Loss-of-resistance technique, 131, 132 704 Index

Low back pain definition, 141, 142 intervertebral disc, 301 discogenic pain, 141, 143, 145 radiofrequency energy, 301 epidural space, 147–151 Lower extremity joint injections, 645–654 extra-epidural placement, 161–163 ankle (see Tibiotalar injection) indications, 145 femoroacetabular (see Femoroacetabular Joint Injection) interlaminar approach, 153, 156–160 GTPS, 622, 623 low back and lower extremity pain, 141 IP bursa, 621, 622 lumbar radiculitis, 145 knee (see Femoral tibial injetion) nerve and vertebral canal, 149, 152 PAB (see Pes anserine bursitis (PAB)) pathophysiology, 142–144 precautions, 625 RCTs, 142, 145 RB (see Retrocalcaneal bursitis (RB)) side effects and complications, 179–180 side effects and complications, 625 transforaminal approach (see Lumbar transforaminal epidural Lower extremity nerve blocks and neurolysis injections) CPN, 513 treatment, 180, 183 genitofemoral nerve, 509, 510 vasculature, 151–155 interdigital neuritis, 514, 515 Lumbar facet joint intra-articular injections, 356–357 LFCN, 510, 511 Lumbar facet joint neurolysis, 6 obturator nerve, 512, 513 Lumbar facet joints Tarsal tunnel syndrome, 514 anatomic and pathophysiologic aspects, 354 Lumbar central spinal stenosis, 243 back pain, 349 Lumbar decompression. See Percutaneous image-guided clinical features, 351 lumbar decompression (PILD) complications, 365 Lumbar discography diagnostic and therapeutic, 351 anatomy, 277 diagnostic blocks, 351 annular tears, 287 diagrams, 351 Dallas discogram classification, 286 evidence, 350 diagnostic tool, 274 fluoroscopic views, 356 diagnostic validity, 274 indications, 353 disc injection mechanical injury, 350 abnormal discographic patterns, 280, 285 MIA, 350 annular pathology, 280 placebo effect, 353 completion, 282 precautions, 365–366 intradiscal pressure, 280 principles, 352 L4/5 disc level, 284 radiofrequency, 363 L4/L5 level, 280 referral patterns, 352 L5/S1 level, 280 role, 350 needles position, 280 side effects and complications, 364–365 normal discograms, 280 structure, 353 pain level, 280 technical aspects, 356–364 pain quality, 280 therapeutic procedures, 349 step-by-step approach, 280, 283 validity, 353 extraspinal technique, 278 Lumbar ganglia, 555 functional anesthetic, 276 Lumbar interlaminar epidural adhesiolysis, 259 imaging Lumbar laser disc decompression, 313 CT, 282 Lumbar postsurgery syndrome, 142 dallas discogram classification scheme, 282 Lumbar spinal stenosis, 244 MRI, 282 Lumbar spine, 76 multiple grades, annular tear, 282 Lumbar sympathetic block normal, moderate and severe degeneration, 282 anatomic variations, 555 posterior annular tears (PAT) disruption, 282 anatomy, 552–555 low back pain, disc, 273 approaches, 556 MRI, 275 fluoroscopy views, 556 needles, 280 imaging, 551 normal, moderate and severe degeneration, 288 indications, 552 oblique anatomy, 278 neurolysis, 551 positioning, 278–280 pathophysiology, 551–552 posterior annular tears (PAT) disruption, 289 placebo-controlled trials, 552 precautions, 296 Lumber central spinal stenosis, 243 procaine injection, 273 provocation, 276 rationale, 276 M reports, 273 Magnetic resonance imaging (MRI), 90, 91, 301 transdural technique, 278 Mandibular nerve block, 457 Lumbar epidural injections, 161, 187 Maxillary nerve block, 457 anatomy, 145–153 Mechanical disc decompression, 322 caudal epidural procedure, 174–182 Mechanical injury, 350, 370 Index 705

Medial branch blocks, 357–359, 379, 380 cancer pain, 32 Medial branch nerves, 361 local anesthetic injection, 32 Median nerve block, 502–504 phenol, 32 Meralgia paresthetica, 510, 511 Neuropathic and nociceptive pains, 16 Microdiscectomy, 313 Neuropathic pain syndromes, 552 Microvascular decompression (MVD), 453 Nociceptive-specific (NS), 20 Mid-back pain, 188 Nonsteroidal anti-inflammatory drug (NSAID), 350, 382, 388 Migraine, 630 Nucleoplasty Moderate sedation, 42–44, 46 percutaneous disc decompression, 332, 333 Modulation Numerical rating scale (NRS) scores, 302 central spinal mechanisms, 19, 21 central supraspinal mechanisms, 22 peripheral mechanisms, 19 O Monosodium iodoacetate (MIA)., 350 Obturator nerve (ON) blocks, 512, 513 Morton’s neuroma, 514 Occipital nerve block, 463–468 Motor cortex stimulation (MCS), 683 Occipital nerve stimulation (ONS) Motor stimulation, 567 anatomy, 688 mu opioid receptors (MOR), 19 complications, 689 Multiple psychological mechanisms, 533 diagnostic occipital nerve block, 688 Musculoskeletal disorders, 617 occipital neuralgia, 688 Myelography, 91 procedure, 688, 689 Myofascial pain syndrome (MFPS), 611, 631 refractory headache, 688 Myofascial trigger points (MTrPs) Occipital neuralgia, 688 central sensitization, 612 AHS-IPS, 465 defined, 611 anatomy, 465, 466 diagnosis, 613 blunt Stealth™, 467 integrated hypothesis, 612 causes, 467 diagnosis, 464 differential diagnosis, 464 N dysesthesia, 463 Neck pain, 209, 210 GON, 466–468 Needle manipulation history, 463 anatomic structures, 132 idiopathic causes, 463 aspiration test, 138 indications, 465 bevels, 135, 136 injury, 463 contrast injection, 138 local anesthetic, 466 fluoroscopy, 132 LON, 466, 467 fluoroscopy beam, 132–134 ONBs, 466 hub rotation, 136, 137 pain, 466 injection, active medication, 138 peripheral nerve blocks, 464 interventional pain management, 125 physiopathology, 463 local anesthesia, 129 precautions, 468 loss-of-resistance technique, 131, 132 protuberance, 467 needle shaft, 137 side effects and complications, 468 patient positioning, 126–128 structural pathology, 463 room setup, 125 symptoms, 464 safety and accurate needle placement, 129–138 TON block, 468 skin insertion point, 128, 129 unilateral/bilateral paroxysmal, 463 steering needles, 135 Oral pain, 521 tactile techniques, 130, 131 Osteoporotic fractures, 432 tip position, 134, 135 “Out-of-plane” approach, 447, 448 visibility, 133 Nerve blocks ilioinguinal, 494, 495 P paravertebral, 492, 493 Pain signaling rectus sheath, 490–492 modulation TAP block (see Transversus abdominal plane (TAP) block) central spinal mechanisms, 19–22 Nerve fibers, 16–19 central supraspinal mechanisms, 22 Neurolysis peripheral mechanisms, 19 chemical, 455 perception, 22, 23 glycerol, 455 transduction, 16 radiological guidance, 454 transmission, 16–19 Neurolytic procedures, 546 Pancreatic cancer, 595, 596 Neurolytics Paradiscal extraforaminal approach adverse effects, 32 benefits, 564 agents, 32 Paradiscal extraforaminal technique, 561 alcohol, 32 Paramedian, 556 706 Index

Paramedian approach, 592 myelographic patterns, 265 Parasympathetic nervous systems, 536 myelographic/subarachnoid patterns, 261–263 Paravertebral nerve block pain and disability, 241 blind technique, 492 palpation, 256 fluoroscopic guidance, 493 post-lumbar laminectomy syndrome, 242 fluoroscopy, 492 post-surgery syndrome, 241 local anesthetic, 493 procedure, 269 precautions, 493 Racz technique, 255 somatic and sympathetic, 492 rationale, 243 spinous process, 492 Sciatica-like pain, 242 surgical anesthesia, 492 side effects and complications, 267, 268 thoracic, 492 special needle and catheter, 257 treatment, chronic pain, 493 spinal stenosis, 241 ultrasound, 492 subarachnoid patterns, 266 Pelvic malignancy, 574 subdural placement, 263, 264, 266 Pelvic pain, 581 techniques, 255 Percutaneous adhesiolysis therapeutic effectiveness, 245 anatomy transforaminal approach, 264–267 arterial supply, spinal cord, 253 Percutaneous disc decompression cauda equina transits, 251 anatomy, 315–320 cervical and lumbar spine, 245 disc herniations, 315 coccyx, 245, 251 indications, 314 epidural space, 247 nucleoplasty, 313 epidural veins, 247 precautions, 333, 334 ligamenta flava, 251 relative/absolute contraindications, 314 ligamentum flavum, 247 technical aspects lumbar vertebral canal, 248 automated percutaneous lumbar discectomy, lumbosacral spine, 249 323–325 neuraxial compartment, 247 dekompressor, 327, 328 sacral hiatus, 251 hydrodiscectomy, 328–332 sacrum, 248 lumbar laser discectomy, 325–327 spinal canal and the epidural space, 250 mechanical high RPM device, 327, 328 spinal cord, 247 nucleoplasty, 332 spinal cord segments and spinal nerves, vertebrae, 254 posteroanterior view, radiologic anatomy, 321 spine division, 245 postoperative care, mechanical disc decompression veins, spinal cord and vertebral column, 252 patients, 333 vertebral column, 246, 247 Percutaneous image-guided lumbar decompression (PILD) animal models, 243 anatomy, 425–427 antithrombotics and anticoagulants, 269 hypertrophic ligamentum flavum, 425 Aspirin and NSAIDs, 269 mild®, 427–429 back pain, 243 minimally invasive, 423 caudal, 265 pathophysiology, 424 caudal approach, 255–258, 260 precautions, 428, 429 caudal epidural, 264 RCT, 424 caudal epidural adhesiolysis, 261 side effects, 429 central lumbar spinal stenosis, 243 spinal canal stenosis, 423 chronic spinal problems, 241 treatment, 425 complications, 268 Percutaneous laser discectomy (PLD) deleterious effects, epidural scarring, 241 herniated disc, 310–312 epidural, 263 nucleus pulposus, 313 epidural fibrosis, 241 rationale, 312, 313 evidence based, 243 side effects and complications, 333 history, 241 Percutaneous lumbar discectomy hypertonic saline, 268 herniated discs, 309 indications, 243 Percutaneous lumbar laser discectomy, 325–327 injection, 268, 269 Percutaneous neurolytic procedures (PTN), 453 interlaminar lumbar approach, 257–259 Periaqueductal gray-rostral ventromedial medulla local anesthetic, 268 (PAG-RVM) system, 22 lumbar disc degeneration, disc herniation and discogenic pain, 242 Perineal pain, 581 lumbar epidural adhesions, 262 Peripheral nerve blocks, 465, 466, 497 lumbar epidurogram, 262 Peripheral nerve stimulation (PNS) lumbar spinal stenosis, 244 anatomy, 686, 687 Manchikanti technique, 259–261 cephalgias, 686 mechanical lysis, 241 evidence, 684, 685 multiple antiplatelet agents, 269 history, 683 Index 707

interstitial cystitis, 686 Provocation discography limb locations, 687 accuracy, 277 nerve fibers, 687 adjunct/replacement, 273 neuropathic pain, 686 anatomical controls, 276 pathophysiology, 683, 684 ASIPP guidelines, 276 precautions, 691, 692 diagnostic criteria, 276 rationale, 685, 686 interventional diagnostic tests, 274 side effects and complications, 691 Level III, 276 technical aspects lumbar, 276 IC, 690, 691 Pseudomotor-edema, 535 ONS, 688, 689 Pterygopalatine fossa, 522, 523, 525, 526, 528 TNS, 689, 690 Pulsed mode radiofrequency, 405 Peripheral nervous system (PNS), 15 Pulsed radiofrequency (PRF), 453, 456 Peripheral vascular disease (PVD), 659, 662 Pulsed radiofrequency lesioning of suprascapular Permanent implant, 676, 677 nerve, 471, 478 Persistent idiopathic facial pain, 521 Pes anserine bursitis (PAB) anatomy, 623 R corticosteroids, 623 Radial nerve block, 500–502 diagnosis, 623 Radiation exposure history, 623 ALARA, 118 pathophysiology, 623 direct and scatter radiation, 115 ultrasound-guided injection technique, Radiculopathy 623, 624 imaging Pharmacotherapy cervical spine, 107 anesthetics (see Local anesthetics) lumbosacral spine, 106, 107 benefits and risks, 27 thoracic spine, 107 contrast agents, 31 Radiofrequency (RF) corticosteroids, 29–31 ablation of intercostal nerves, 485–486 medications, 27 ablation, 342 neurolytic agents (see Neurolytics) coblation, 314 pain, 27 GON, 468 Placebo effect, 353 lesioning, 380 Placebo-controlled trials, 552 nerve ablation, 463 Plavix®, 366 neurotomy, 353, 468, 469 Plexus, 686 thermocoagulation, 453 Post cervical surgery syndrome, 210, 212 Randomized controlled trials (RCTs), 142, 145, 188, Posterior approach, 202 302, 389 Posterior ramus (PR), 377 Raynaud’s disease, 535 Posterior ramus bifurcates, 375 Rectus sheath block Posterior tibial nerve (PTN), 513 color Doppler, 491 Post-lumbar laminectomy syndrome, 242 fibrous extensions, 491 Post-lumbar surgery syndrome, 241, 243, 269 iatrogenic peripheral nerve injuries, 490 Practice patterns, pain management indications, 491 antithrombotic therapy, 54 needle courses, 491 apixaban, 57 neural structures, 491 coronary artery stenting, 54 postoperative analgesia, 490 excessive bleeding, 55 precautions, 492 NSAIDs, 55 real-time sonography, 491 oral anticoagulants, 55 simulated needle path courses, 491 phosphodiesterase inhibitors, 55 ultrasound transducer, 491 platelet aggregation inhibitors, 55 visualization, 491 recommendations, 55 Reflex sympathetic dystrophy (RSD), 531, 532, 548, 552 risks, hemorrhagic complications, 54 Regional anesthesia, 3 rivaroxaban, 57 Registered nurses (RNs), 41 unfractionated heparin, 55 Retrocalcaneal bursitis (RB) Warfarin, 55 achilles tendon (AT), 624 Pradaxa®, 366 anatomy, 624 Procedural documentation, 36, 38 diagnosis, 624 Procedural sedation evidence based, 624 cardiopulmonary complications, 46 inflammation, 624 events associated, 42, 49 pathophysiology, 624 medications, 48 ultrasound-guided injection technique, 624–625 Prone position anteroposterior, 361–362 Retrograde ejaculation, 569 Prone position oblique, 359–361 Retroperitoneal hematoma, 495 708 Index

RF lesioning, 565–566 Shoulder joint injection Rheumatalgia, 611 ultrasound, 640 Rhizotomy, 453, 459, 460 Single-photon emission computed tomography (SPECT), 433 Single-photon emission computed tomography (SPECT) system, 90 Sluijter’s technique, 566–568 S Spasticity, 671–673, 678, 679 Sacral fractures, 431, 432 Sphenopalatine ganglion (SPG) blocks Sacrococcygeal junction (SCJ), 581 anatomy, 522, 523 Sacroiliac joint interventions evidence base, 519–521 anatomy, 340, 341 facial and head pain, 519 clinical observations, 337 headaches, 521 diagnosis, 339, 340 indications, 521, 522 evidence base, 339 internal carotid plexus, 519 fluoroscopic guidance, 337 modified transnasal, 527 indications, 339 precautions, 528 low back pain, 337 pterygopalatine ganglion, 519 pathophysiology, 337–339 side effects and complications, 528 precautions, 346 technical aspects radiofrequency lesioning modes, 343 infrazygomatic approach, 523–525 sacroiliac physical exam tests, 340 intranasal approach, 523 side effects and complications, 345 radiofrequency lesioning, 527–528 technical aspects transnasal approach, 525–527 diagnostic blocks, 341, 342 trigeminal neuralgia, 519 radiofrequency techniques, 342–345 Spinal column Sacroplasty anterior vertebral body and posterior elements, 68 image guidance, 438 central spinal canal, 66 needle placement, 438, 439 characteristics, 63 pre-procedure, 438 compartments, 67 Safety precautions, 53 complex structure, 63 Sedation medications division, 66 benzodiazepines, 47 inferior articular process, 67 dexmedetomidine, 49 lumbar vertebra, 66 flumazenil, 49 lumbosacral spine, 69 ketamine, 48, 49 spinal motion segment, 67 naloxone, 49 variation, 63 opioids, 47 vertebral, 65, 66 propofol, 47 vertebral levels, 66 Sedation, interventional techniques zygapophysial joints, 67 advantages and potential problems, 45 Spinal cord anesthesia and analgesia, 41 blood supply, 85 considerations, 46 and nerve roots, 80, 81 deep sedation analgesia, 46 Spinal cord compression, 268 events associated, 49 Spinal cord stimulation (SCS), 683 evidence base abnormal stimuli, 660 diagnostic interventions, 43, 44 anatomical features, dorsal column, 664 therapeutic interventions, 44, 45 cauda equina, 660 general anesthesia, 46 chronic painful conditions, 659 history, 41, 42 constant voltage outputs, 664 medical necessity, 42, 43 DBS, 659 medications (see Sedation medications) electrical, CNS, 659 minimal sedation, 46 electrodes, 664 moderate sedation, 46 epidural space extension, 662 non-anesthesiologist and nonphysician practitioners, 41 evidence synthesis, 660 operative and procedural pain, 42 fluoroscopy, 666, 667 recovery and discharge, 49 foramen magnum, 662 safety, conscious sedation, 42 glial cells, 660 sedation depth monitoring, 46–47 history, 659 side effects and complications, 49–50 indications, 662 Selheim’s technique, 551 intensity, electrical field, 664 Short tau inversion recovery (STIR), 433 ipsilateral area, 664 Shoulder disorders lead placement technique, 665–667 subacromial-subdeltoid, 617 leads and contact electrodes, 663 Shoulder injection nerve injury, 660 diagnostic and therapeutic, 636 neurostimulation technique, 659 evidence base, 637 pain target and lead location, 665 pathophysiology, 637 paramedian fashion needle approach, 664 Index 709

peripheral nerve injury, 660 precautions, 625 peripheral sensitization, 660 side effects and complications, 625 precautions, 667, 668 Thermal annular procedures (TAPs), 301 rationale, 661, 662 annulus, 301 segments, 660 CMS, 301 side effects and complications, 667 complications, 305 supraspinal effects, 660 Thermal intradiscal procedures (TIPs), 301 surgical paddle and percutaneous leads, 665 Thermocoagulation, 589, 592, 593 therapeutic effectiveness, 661 Third occipital nerve (TON), 408 thickness, dCSF, 663 Thoracic discogenic pain, 187, 188, 205 transversal section, 662 Thoracic discography transverse section, 663 anatomy, 277 trial, 665 “box” configuration, 293 vertebral level, 660 cadaver, 294 Spinal discography, 274 chronic upper and mid back pain, 276 Spinal stenosis, 142, 188 CT-discogram, 296 Spinous processes, 376 discograms, 294, 295 Splanchnic nerve blocks. See Celiac plexus blocks diagnostic tool, 274 Spondylodiscitis, 107 disc entry Spondylolisthesis, 70–71 cadaver, 293 Spondylolysis, 70–71 C-arm, 293 Star-shaped stellate ganglion, 536 extraspinal technique, 291 Stellate ganglia, 537–539 needle-induced annular pain, 292 Stellate ganglion block, 546 procedure, 291 Steri-Strips™, 666 provocative pain response, 292 Suboccipital compartment injection, 467, 469 disc injection SUNCT syndrome, 453 completion, 293 Superficial radial nerve anatomy, 501 CT imaging, 294 Superior mesenteric artery (SMA), 596, 597 multiple thoracic discograms, 293 Supraneural approach, 201, 202 needles position, 293 Supraorbital and supratrochlear nerves, 458 pain level, 293 Suprascapular nerve block pain quality, 293 acute pain, 472 evidence, 277 anatomy, 472, 473 explorations, 273 anterior approach, 474 intervertebral disc, 277 Blind Technique, 474 literature, 276 chronic pain, 472 MRI, 274 clinical conditions, 471 reports, 275 diagnosis, 472 Thoracic epidural injections direct approach, 474 anatomy, 188–194 epinephrine, 473 fluoroscopy, 194 ganglion cysts, 472 interlaminar and transforaminal approaches, indications, 472 188, 194 Medication protocol, 473 pathophysiology, 187, 188 neurolysis, 477–478 precautions, 204, 205 neuropathy, 471 side effects and complications, 204 painful conditions, 471 Thoracic facet joint interventions physical examination, 473 anatomy, 372 posterior approach, 474 anteroposterior view, 377 posteromedial approach, 474 back or upper back pain, 369 precautions, 478 clinical features, 371 radiographic technique, 474–475 complications, 380, 382 shoulder joint, 471 diagnostic, 372 side effects and complications, 478 diagnostic and therapeutic, 371 superior approach, 474 features, 374 ultrasound technique, 475–477 innervation, 374 Suprascapular neurolysis, 477–478 medial branch blocks, 369 Suprascapular notch, 472, 474–476, 478 pathophysiology, 369–370 Sympathetically independent pain (SIP), 551 prevalence, 369 Sympathetically mediated pain (SMP), 551 principles, 371 rationale, 372 role, 369 T technical aspects, 376–380 Tarsal tunnel injection, 513–514 therapeutic evidence, 370 Tarsal tunnel syndrome, 513 types, 370 Tegaderm™, 666 validity, 372 Tendon sheath vascular structures, 376 710 Index

Thoracic facet joint referral pain patterns, 371 multiple risk reduction, 165 Thoracic interlaminar epidural injection, sacroiliac transforaminal, 169–173, 175–177 188, 195, 197 safe triangle, 165 critical anatomy, 199–201 safe triangle approach, 167, 169 extra-epidural placement supraneural and infraneural approach, 161 dural puncture, 195 Transmission, 16–19 subdural compartment, 197 Transsacral approach, 573, 577 fluoroscopy, 194 Transsacral inferior hypogastric block, 577–578 indications, 188 Trans-sacrococcygeal approach, 586, 588, 591, 593 infraneural approach, 202–204 Transversus abdominal plane (TAP) block supraneural approach, 202 anatomy, 489 technical implications, 201, 202 applications, 489 transforaminal, 198 catheter delivering, 490 Tuohy needle, 194 image guidance, 489 typical PA epidurogram, 195 needle courses, 490 Thoracic needle placement for medial branch blocks, 381 neurolysis, 490 Thoracic postsurgery syndrome, 188 percutaneous loss-of-resistance technique, 489 Thoracic spinal stenosis, 188 precautions, 490 Thoracic sympathetic block, 545 sensory innervation, 489 Thoracic transforaminal epidural injections, 198, 201 sonoanatomy, 490 complications, 204 sonography, 490 infraneural approach, 203 subcostal and ventral approaches, 490 intradiscal placement, 204 surgical procedures, 489 Thoracic vertebrae, 373 ultrasound transducer, 490 Thrombotic risks with discontinuation, 53, 54 Traumatic injuries Tibiotalar injection acute fractures, 100, 102 anteromedial vs. anterolateral, 652 chronic fractures, 103 articulation, 652 operative trauma and complications, 104 diagnosis, 652 subacute fractures, 103 efficacy, corticosteroids, 652 Trigeminal nerve block fluoroscopy guided, 653 chemical neurolysis, 455 history, 651 complications, 459 intra-articular ankle joint, 651 infraorbital nerve, 458 landmark-guided, 652 maxillary and mandibular nerves, 457 lateral mortise, 653 mental nerve, 458 muscles/tendons/ligaments, 652 needle insertion, 454–456 neurovasculature, 652 patient position, 454 pathophysiology, 651 radiofrequency, 455, 456 plantarflexion, 652 side effects, 459 preparation, 652–653 steroid, 455 primary motion, 652 supraorbital and supratrochlear nerves, 458 side effects and complications, 654 terminal branches, 457, 458 ultrasound, 653, 654 X-ray technique, 454, 455 ultrasound-guided approach, 653 Trigeminal nerve stimulation (TNS), 689, 690 viscosupplementation, 652 Trigeminal neuralgia Tic douloureux, 451 demyelination, 451 Ticlid®, 366 diagnosis, 453 Tietze’s syndrome, 481 ganglion procedures (see Trigeminal nerve block) Time gain compensation (TGC), 446, 449 microvascular decompression, 451 Toxicity multiple sclerosis, 452 cytochrome P450 CYP2D6, 28 PRF, 453 local anesthetics, 27 rhizotomy, 453 nephrotoxicity, 32 trigeminal ganglion, 452, 453 neurotoxicity, 28 vascular decompression, 452 systemic, 32 Trigger point injections Transdiscal approach, 577 botulinum toxin A, 613 Transdiscal lumbar sympathetic block, 559–561 complications, 614 Transdiscal superior hypogastric block, 577, 578 dry needling, 611–613 Transduction, 16 injection procedure, 613, 614 Transforaminal epidural adhesiolysis, 267 myofascial pain syndrome, 631 Transforaminal epidural injections pathophysiology, 612 anatomy, 161–166 precautions, 614 extraneural placement, needle, 172–174, 178 side effects, 614 Kambin’s triangle approach, 166–168, 170, 171 Tuohy needles, 194 Index 711

U precautions, 625 Ulnar nerve block, 504, 505 SASDB (see Bursa) Ultrasound shoulder (see Shoulder injection) acromioclavicular joint injection, 637–638 side effects and complications, 625 advantages and disadvantages, 448 sterile preparation, 635 anatomical structure, 447 Upper extremity nerve block anisotropy, 447 axillary nerve, 499, 500 axial resolution, 445, 446 brachial plexus, 497–499 biceps tendon sheath, 619–620 median nerve, 502–504 carpal tunnel injection, 641 radial nerve, 500–502 De Quervain’s Tenosynovitis, 620–621 ulnar nerve, 504, 505 depth, 449 Upper extremity pain, 210, 212 echogenicity, 446 frequency, 446 gain, 449 V glenohumeral joint injection, 639 Value-based interventional pain management, 3 image artifact, 448 Vertebral fractures, 432 “in-plane” approach, 447 Vertebroplasty lateral resolution, 445, 446 anatomy, 435 musculoskeletal injuries, 445 cancer, 432 operative functions, 448, 449 diagnosis, 432–435 “out-of-plane” approach, 447, 448 internal fixation, 432 PAB, 623, 624 needle placement, 436 particle vibration, 445 osteoporotic vertebral fractures, 431, 432 piezoelectric effect, 445 percutaneous image-guided procedures, RB, 624–625 431, 435, 436 SASDB, 618 post-procedure, 440 Ultrasound-guided intercostal nerve blocks, 484–485 precautions, 440, 441 Upper extremity injections pre-procedure, 435 acromioclavicular joint, 637, 638 radiation exposure, 437 Biceps Tendon Sheath (see Biceps tendon sheath) sacral fractures, 431, 432 carpal tunnel (see Carpal tunnel injection) side effects, 440 complications Visceral pain, 662 infectious, 636 Visual analog scale (VAS) pain scores, 45, 302 noninfectious, 636 tissue trauma and bleeding, 636 De Quervain’s Tenosynovitis, 620, 621 W elbow joint (see Elbow joint injection) Wide dynamic range (WDR) neurons, 20, 551 factors, 635 glenohumeral, 638, 639 glucocorticoid, 636 X indications, 635 Xarelto®, 366 local anesthesia, 635 medication, 635 needle and syringe size, 635 Z physical examination maneuvers, 618 Zygapophysial joints, 353