What is a SNRB vs TFESI??

[painfree23]

The IPSIS-recommended changes have clarified previously confusing reporting requirements that failed to differentiate between Selective Nerve Root Blocks (SNRBs) and Transforaminal Epidural Steroid Injections (TFESIs). For the MACs listed below, procedural reports should now incorporate baseline pain scores alongside the percentage of pain relief achieved immediately after the injection for SNRBs only. This requirement aims to enhance the accuracy and completeness of reporting for SNRBs and does not apply to TFESIs.”

Clinically is there a difference in these two?

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[sdnuser001]

No difference as far as I know

 

[nvrsumr]

Unicorn that spine surgeons believe in. Snrb includes local and needle tip more lateral so meds should not go into epidural space. “selective” to that one nerve root. In practice the local gets into epidural space.

Could mix contrast with local/dex and do under live Fluoro if really wanted and stop before contrast past pedicle

I also agree terms used interchangeably

 

[Taus]

It just means you don’t have to report this bs anymore for tfesi

 

[Ducttape]

difference in procedure?

maybe in that some of us never use local anesthetics for TFESI, and that a surgeon cannot tout diagnostic value with tfesi where they may spout such talk with SNRB.

there was a local doc who did SNRB and stated that he placed the needle tip purposefully 0.5 cm distally compared to tfesi and said that this injection is diagnostic, and meds wont spread... as he injected 2 ml of LA with 40 depo...

 

[sdnuser001]

Spine surgeon is requesting marcaine in the SNRB and I'm mostly doing office injections. What extra precautions do I need to take if I'm going to be adding some marcaine to the injectate? Do I need to request the patients have a driver in case they develop weakness? What are the extra risks honestly? Can you really even get motor blockade with 0.25% marcaine?? And how much local do you guys typically put in the injectate...TIA

 

[bedrock]

Spine surgeon is requesting marcaine in the SNRB and I'm mostly doing office injections. What extra precautions do I need to take if I'm going to be adding some marcaine to the injectate? Do I need to request the patients have a driver in case they develop weakness? What are the extra risks honestly? Can you really even get motor blockade with 0.25% marcaine?? And how much local do you guys typically put in the injectate...TIA

Just don’t. The surgeon is a douche for asking specifically for marcaine. No reason to do Marcaine over lidocaine and even lidocaine isn’t foolproof.

Or course every SNRB patient needs a driver. That’s not even debatable.

 

[Taus]

Spine surgeon is requesting marcaine in the SNRB and I'm mostly doing office injections. What extra precautions do I need to take if I'm going to be adding some marcaine to the injectate? Do I need to request the patients have a driver in case they develop weakness? What are the extra risks honestly? Can you really even get motor blockade with 0.25% marcaine?? And how much local do you guys typically put in the injectate...TIA

I’d prob put max half cc of 0.5% marcaine. Yes to driver.

 

[SSdoc33]

Spine surgeon is requesting marcaine in the SNRB and I'm mostly doing office injections. What extra precautions do I need to take if I'm going to be adding some marcaine to the injectate? Do I need to request the patients have a driver in case they develop weakness? What are the extra risks honestly? Can you really even get motor blockade with 0.25% marcaine?? And how much local do you guys typically put in the injectate...TIA

Surgeon doesn’t know what he is doing.

We have been over this. SNRBS aren’t selective. If the surgeon can’t tell which level it is by history and exam then MAYBE an emg could. But not a spine injection

As far as which local? Doesn’t really matter. Lido is just better bc any motor block wouldn’t last as llong