MILD procedure

[runfastnow]

For those of you doing MILD do you perform in a true OR or ASC procedure room/same room you do ESIs, RFs, etc.?

When I started doing them the ASC wanted them done in OR and now pushing to move them to my procedure room in the ASC.

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[pmrmd]

You can do MILD in procedure room easily.

 

[Ducttape]

same procedure room in ASC.

and initially did them under MAC. now light to moderate sedation.

 

[Agast]

What’s the difference between your procedure room and the OR? Ability to fit an anesthesia machine?

 

[GlowInTheDark]

I did training on this procedure almost 2 years ago, and in the time since then I've probably seen 4 patients who I think could benefit from it. Unfortunately, the hospital where I do Intracept won't credential me to do it without a proctor, and the company will only send me a proctor if I get 4 cases lined up on the same day. So I guess I'm just not going to do it.

Exact same situation here.

 

[runfastnow]

What’s the difference between your procedure room and the OR? Ability to fit an anesthesia machine?

Mainly that. Procedure room is cozy and initially staff freaked out when they saw the procedure done and said it should be done OR.

 

[PinchandBurn]

Mainly that. Procedure room is cozy and initially staff freaked out when they saw the procedure done and said it should be done OR.

If you can do a kypho there you can do mild there. Same with intracept. The openings are small. Risk of infection with good technique is small I thinj

 

[CleanUp]

If you can do a kypho there you can do mild there. Same with intracept. The openings are small. Risk of infection with good technique is small I thinj

If you care about infections then add some preop and post op abx. I know the data isn’t stellar but I don’t see much of a down side.

 

[BobBarker]

There is good data for preop antibiotics. Post op has not shown to be helpful in studies but for SCS, ITP’s, DBS, other implants I’m not sure it has been specifically shown to not be helpful. I give post op antibiotics for scs and haven’t had an infection since 2018. But I’m a lot better surgically now, than I was in 2018.

 

[Ronin1]

I think it is reasonable to give a single dose of iv antibiotics before mild, Intracept and scs trials.

 

[PinchandBurn]

I think it is reasonable to give a single dose of iv antibiotics before mild, Intracept and scs trials.

I give post op for 3 days for intracept and mild.


Could it be voodoo? Maybe. I have heard about good docs getting infections ..

Trials always antibiotics during duration of trial. It's how we trained. U have an external device going into the Spine. Also same for stim implant.

I used to give keflex qid.

A friend of mine switched to doxy 100mg bid. States patients are more complaint with doxy and does it for 10 days

 

[lobelsteve]

If you care about infections then add some preop and post op abx. I know the data isn’t stellar but I don’t see much of a down side.

I give IV ABX pre-op kypho in office or OR.
No post-op ABX for anything.

 

[Espn123]

I think it is reasonable to give a single dose of iv antibiotics before mild, Intracept and scs trials.

Or standard of care

 

[CleanUp]

There is good data for preop antibiotics. Post op has not shown to be helpful in studies but for SCS, ITP’s, DBS, other implants I’m not sure it has been specifically shown to not be helpful. I give post op antibiotics for scs and haven’t had an infection since 2018. But I’m a lot better surgically now, than I was in 2018.

Yes any anesthesiologist knows the pre op abx given a certain time before incision has value. I was referring to the post op dose.

 

[Forwho]

Any of you holding ASA 325 for the procedure? Usually don't for the bread and butter injections but on the fence about this.

 

[Espn123]

Any of you holding ASA 325 for the procedure? Usually don't for the bread and butter injections but on the fence about this.

I stop that w a clearance for all esi and this

 

[Ducttape]

never hold aspirin.

not even for MILD.