Splanchnic technique article - anyone have?

[NJPAIN]

Anyone have a copy of the following that they are willing to share? Trying to save the $35 fee to
download.

Radiofrequency ablation of splanchnic nerves for control of chronic abdominal pain
Kapural, Leonardo
Techniques in Regional Anesthesia & Pain Management , Volume 19 , Issue 3 , 138 - 142

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[Papa Lou]

He does a ton of Stim for this (I think). I assume it's b/c the RF doesn't work.
Given the amount of futzing and needle placement adjustments required to burn a small segment where the medial branches run in the spine, to burn the large segment of space enough to cover the necessary nerves seems ridiculous. I don't buy it.
So I would love to see that copy as well.

 

[clubdeac]

I'd put 4 needles in, 2 on each side at the mid T11 and T12 vertebral bodies and then do about 4 burns at each site. It is a crap shoot though as the nurses cross the bodies at variable locations on their way to the celiac. 6% phenol or 98% alcohol are the way to go.... assuming we're treating pancreatic cancer. Anything else and you're probably putting your neck out there a little too far

 

[drpainfree]

I don't have this particular article, but have the following article for references. Here you go, if it's any help. I'd love to get hold of Kapural's articles, too.

 

[unchockey21]

He does a ton of Stim for this (I think). I assume it's b/c the RF doesn't work.
Given the amount of futzing and needle placement adjustments required to burn a small segment where the medial branches run in the spine, to burn the large segment of space enough to cover the necessary nerves seems ridiculous. I don't buy it.
So I would love to see that copy as well.

Pain fellow with Kap currently. He does do a lot of Nevro for abdominal pain but it's because he does a lot of abdominal/pelvic pain in general and finished a study for it this year. Results I've seen this year from the splanchnic RFs have been very good. I've done around 25 myself so far and there's been minimal futzing needed to get appropriate stimulation. Most of the SCS is from when the splanchnic blocks didn't work in the first place.

 

[DOctorJay]

does he place the Nevro leads a the typical location or is there a better anatomic position for abdominal pain?

 

[clubdeac]

Pain fellow with Kap currently. He does do a lot of Nevro for abdominal pain but it's because he does a lot of abdominal/pelvic pain in general and finished a study for it this year. Results I've seen this year from the splanchnic RFs have been very good. I've done around 25 myself so far and there's been minimal futzing needed to get appropriate stimulation. Most of the SCS is from when the splanchnic blocks didn't work in the first place.

Where exactly does he place the needles. And like DocJay asked, where does he place the stim leads

 

[EtherBunny]

Where exactly does he place the needles. And like DocJay asked, where does he place the stim leads

Also, how on earth is he getting reimbursed for stim on abdominal pain? i can't imagine that insurance companies will pay for this indication.

 

[NJPAIN]

does he place the Nevro leads a the typical location or is there a better anatomic position for abdominal pain?

T4-5


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[NJPAIN]

Also, how on earth is he getting reimbursed for stim on abdominal pain? i can't imagine that insurance companies will pay for this indication.

NEVRO - "trunk pain"


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[lobelsteve]

Success rates improve the more patients are lost to follow up.

BOCF for some means best observation carried forward. Not baseline.

 

[Aether2000]

All of these techniques, splanchnic RF and stim for abdominal pain are great in academia but will never have widespread acceptance or practice due to lack of reimbursement. But they are fun toys!

 

[unchockey21]

Where exactly does he place the needles. And like DocJay asked, where does he place the stim leads

Like NJPAIN said, T4 and T5 for stim. For the RF, it's a third of the way across T11 and 2/3 across T12.

 

[unchockey21]

Like NJPAIN said, T4 and T5 for stim. For the RF, it's a third of the way across T11 and 2/3 across T12.

We only ever RF on one side at a time too. I haven't seen any pneumos this year but for the rare chance that you bag both pleura.

 

[nvrsumr]

Like NJPAIN said, T4 and T5 for stim. For the RF, it's a third of the way across T11 and 2/3 across T12.

Interesting. Not where I used to block splanchnics but I always preferred celiacs followed by phenol. abdominal pain is a rabbit hole in pp.

Seems to me like gray rami- nice idea but doesn't work.

I will do icnb, tap and rectus tp if indicated. Not great payment but have had success in nonmalignant pain

 

[unchockey21]

Just happened to have an RF today. Initial positions were slightly dorsal and had stim at 1V. Advanced both needles once to final position in pics and stim at 0.5V.

 

[lobelsteve]

Does no one colimate anymore?

 

[epidural man]

Anyone have a copy of the following that they are willing to share? Trying to save the $35 fee to
download.

Radiofrequency ablation of splanchnic nerves for control of chronic abdominal pain
Kapural, Leonardo
Techniques in Regional Anesthesia & Pain Management , Volume 19 , Issue 3 , 138 - 142

 

[NJPAIN]

What do the patients describe in terms of abdominal stim?
If the get relief how often is Kap willing to repeat before moving to stim?
Where does the differential epidural fit in to the initial assessment?


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[unchockey21]

What do the patients describe in terms of abdominal stim?
If the get relief how often is Kap willing to repeat before moving to stim?
Where does the differential epidural fit in to the initial assessment?


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Varies. Pressure, tingling, pain. If they're getting at least 6 months of relief, he'll keep repeating. I don't think he's done a differential epidural this year so I can't really say.

 

[paindoc007]

What standard injection solution you guys use for this block? CPT Code? Doing one Monday, skeptical if it will work though...

 

[unchockey21]

What standard injection solution you guys use for this block? CPT Code? Doing one Monday, skeptical if it will work though...

15 cc 0.375% bupi on each side. 64520-50. Hope it went well.