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Attending Physician: Brian M Starr, MDPreoperative diagnoses:-Lumbar facet arthropathy-Chronic low back painPostoperative diagnoses: SameProcedure:-Diagnostic L3, L4 Medial Branch Block, _-L5 Dorsal ramus block, _(Diagnostic blockade of L4/5, L5/S1 ZAJ)Anesthesia: LocalComplications: NoneIndication: Pt is a _ year old _male with axial lumbar spinal pain related to facet arthropathy and lumbar spondylosis. _e has failed conservative treatment, including physical therapy and medication management. _e presents today for diagnostic medial branch block at L3, L4, and L5 medial branch nerves on the _ side. Pre-procedure patient rates pain at _/10.Description of procedure:After informed consent was obtained, the patient was positioned prone with the pillow underthe abdomen. Fluoroscopy was performed, vertebral levels identified and double contourseliminated. Image intensifier was placed at the right oblique position and bases of correspondingSAPs were identified. After a sterile prep and drape, a 22 gauge _5 inch spinal needle wereadvanced under fluoroscopic guidance to the bases of corresponding L4, L5, S1, junction of thetransverse process and the SAP. 0.2 mL of Omnipaque was injected through each needle. Novascular uptake was seen. 0.5ml of 0.75% marcaine preservative free was injected.The patient tolerated well without sedation, an aseptic technique was observed, and there wereno apparent complications. Post procedure pain and functional assessment were performed byrecovery nurse and 6 hour pain diary instructions given. Post-procedure patient rates pain at _/10, with decreased point tenderness and improved range of motion.Disposition: Patient remained in the procedure area and discharged according toPACU discharge criteria.Plan:1. 6 hour Pain Diary2. Telephone follow-up. If pt reports positive diagnostic response, schedule for confirmatory block at same levels. ................
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