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  • ESI and Nerve Block

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    Old 01-16-2004, 02:20 PM   #1
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    ESI and Nerve Block

    Could someone tell me the difference between an ESI and a nerve block?? I "thought" the Dr. ordered a nerve block but the pain center said orders said ESI. Are they the same thing?
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    Old 01-17-2004, 09:02 AM   #2
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    Re: ESI and Nerve Block

    HI STAGRE, An epidural is a steroid injection into the epidural space that surounds your spinal cord. Anesthesiologist do epidural nerve blocks during child birth all day long so a good anesthesiologist shouldn't have a problem doing an ESI. It's not the same as an epidural block but the placement of the needle is the same, the epidural space. o anesthesiologist have lots of practice and complications are usually minimal if you have a good Anesthesiologist.

    Often they give you a little Versed to relax and calm you prior to the procedure. It also makes you forget about the procedure because it's an amnesiac. This way they can talk you into another because you don't remember the last one. LOL Just kidding. You will remeber some but the Versed does relax and help the procedure go smoothly.

    ESI are used to calm down irritateed nerve roots and inflamation. A nerve block is a numbing injection directly into the nerve. They generally use a long acting med like marcaine and look for relief of nerve pain or radiculopothy.

    If the block is succesful they may then try to convince you to try nerve ablation. This is when they do a longer version of a block where they destroy the nerve either with chemicals or radiofrequency "RFA". The problem with Nerve ablation is that nerves recover and you must repeat this procedure every 6 months or so for the rest of your life if the nerve problem has no other way to repair itself or can't be repaired sugically it's an option some people take.

    ESI are much less invasive than nerve blocks and generally less painful because they don't have to stick a needle directly into a nerve. That's a real treat that will light you up before the numbing agent they use has a chance to numb the nerve.

    Blocks are worth a try if you have severe radiculopothy or specific nerve pain that can be traced to one specific nerve or nerve root.

    Some people complain of the pain of ESI, This has to do with the amount of epidural space you have. They use pretty much the same amount of cortizone on everyone. If you have plenty of room to recieve the cort. then it doesn't create pressure inside that space. If you have limited room the extra pressure can be pretty painfull untill it disperses. There really is no way to tell in advance just how much room you have in the epidural space to recieve the meds.

    If the first is succesful, they can repeat the ESI 3 times in a year. Usually about 2 months apart and then you have to wait a year untill you can have another round. Some folks get great relief from the antiinflamatory action of cort. Some people don't. You won't know till you try.

    The safest way to do an ESI or block so that they don't nick the dura and cause a spinal fluid leak is to use flouroscopy to guide the needle. If you have had surgery going through scar tissue can make things more difficult and easier to push the needle to hard and end up with a spinal fluid leak.

    This can be fixed but it's a whole nother procedure. If you end up with a nicked dura and a spinal headache I'll be happy to expalin what a blood patch is and how they work.You don't want to know prior to deciding if you want this done. Bottom line, a nicked dura can be repaired and the headache resolved with this procedure, "Blood patch" Good luck and often with ESI, each subsequent ESI they use a little more juice and hopefully you get a little more and lasting relief from each one.
    Take care, Shore

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