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Re: How many SNR's can a person have in lifetime & per year?

Re: How many SNR's can a person have in lifetime & per year?

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Posted by ML Whitworth, M.D. on February 14, 2000 at 19:56:27:

In Reply to: How many SNR's can a person have in lifetime & per year? posted by maria on February 13, 2000 at 13:15:48:

Technically, a selective nerve root block is a diagnostic block using very small volumes placed on the nerve root. Steroids are not used in selective nerve root blocks because the volume of the steroid causes diffusion of local anesthetic onto the dorsal root ganglion and into the epidural space, thus abnegating the diagnostic value. However, many doctors confuse selective nerve root blocks with transforaminal epidural steroid blocks, which are therapeutic blocks using steroids intentionally meant to diffuse into the neuroforamina and into the epidural space. There are no absolute values, but if your doc is using Depomedrol (very bad drug for this since there is a possibility of injection into the nerve sheeth and since Depo contains neurotoxic preservatives, can cause neurodamage) then an average value would be 240-360mg over a 4 week period (3 injections). However, adrenal suppression may occur with this dose and since a transforaminal epidural steroid injection requires less steroid since it is targeted on the nerve root, smaller amounts of steroid are just as useful without the significant side effects. Reductions of 50-67% in the steroid dose are possible using transforaminal epidural steroids (vs. interlaminar steroids). A much better preparation is Celestone soluspan as a steroid. In any case, injections can safely (from steroid overload standpoint) be performed using reduced amounts of steroids administered transforaminally up to every month. Of course, there is always the risk from the needle punctures and risk of direct needle impalement of the nerve root, but this is uncommon. Hope this confusing nebulous answer helps.

: : Help, I am at my wits end!!Does anyone know how many selective nerve root blocks a person can have in a year? And how many should a person have in a lifetime? Different doctors give me different answers.I have bilateral T-6 SNR's done to control pain. They only last about a month. 1st doctor's answer is that joint nerve blocks should only be done 3 times in a lifetime; however, spinal SNR's you can get up to 3 in a year and it doesn't matter how many in a life time. 2nd doctor said he would not get more than 3 SNR's in a lifetime no matter where they are located. 3rd doctor says he would rather have an intrathecal pump put in versus having SNR's for the rest of my life. Can someone please help me with this. Is there any information on the internet?
: : : thanksmaria




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