![]() ![]() Low back pain duration of at least three (3) months, AND Moderate to severe low back pain primarily experienced over the anatomical location of the SI joints between the upper level of the iliac crests and the gluteal fold, AND Sacroiliac Joint Injections are considered necessary and reasonable when all of the following criteria are met: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: Long Island Based Interventional Pain Physician, David Rosenblum, MD discusses Sacroiliac Joint Dysfunction, and CMS’s Covered Indications for Sacroiliac Joint Injection and Diagnostic Nerve Block These techniques contribute to improved surgical outcomes and patient satisfaction in neurosurgical procedures.Ģ023 Update to CMS’ Covered Indications for Sacroiliac Joint InjectionĬMS Covered Indications for SI Joint Injection Ultrasound guidance has enhanced the precision and safety of block administration. Blocks like scalp block, infraorbital block, trigeminal nerve block, cervical plexus block, and erector spinae block offer numerous advantages in specific procedures. Regional anesthesia techniques play a crucial role in neurosurgery, providing effective pain relief and improving patient outcomes. It involves depositing local anesthetic in the plane between the erector spinae muscle and the transverse process.ĮSB provides effective postoperative analgesia and reduces opioid consumption. Ultrasound guidance can be used for superficial CPB, ensuring accurate needle placement and local anesthetic spread.ĮSB is used for pain control in spinal surgeries. Superficial CPB involves injecting local anesthetic superficially into the deep cervical fascia.ĭeep CPB requires depositing local anesthetic deep to the prevertebral fascia.ĬPB helps in monitoring cerebral blood flow during CEA and provides postoperative pain relief. Segment 2: Blocks used for Spinal SurgeriesĬPB is commonly used in carotid endarterectomy (CEA) and cervical spine surgery.ĭifferent levels of CPB can be performed depending on the depth of injection. Ultrasound guidance helps locate the Gasserian ganglion and visualize the trigeminal ganglion, providing a safe and radiation-free procedure for pain relief. Traditionally performed using the paresthesia technique, ultrasound guidance allows real-time visualization and confirmation of local anesthetic spread. Trigeminal nerve block is used for patients unresponsive to medical management of trigeminal neuralgia. Other regional techniques like sphenopalatine ganglion block and maxillary nerve blocks have also been attempted for transsphenoidal surgeries. IOB combined with general anesthesia is beneficial for postoperative pain relief in procedures like endoscopic trans-nasal trans-sphenoidal (TNTS) approach for pituitary tumor excision. Ultrasound guidance provides real-time visualization and accurate needle placement. The IOB can be performed using the classical landmark technique or ultrasound guidance. The infraorbital nerve block targets the infraorbital nerve, which supplies the skin and mucous membrane of the upper lip, lower eyelid, and cheek. It also reduces postoperative pain, the need for rescue analgesics, and pain scores in the early postoperative period. Scalp block offers advantages such as accurate neurological evaluation, pre-emptive analgesia, and hemodynamic stability during surgery. The main indication for a scalp block is awake craniotomy, but it is also used in other procedures like deep brain stimulation and cranioplasty surgery. Ultrasound guidance has improved the precision of block administration. ![]() It is performed by subcutaneous infiltration of local anesthetics (such as bupivacaine, ropivacaine, or levobupivacaine) for each nerve. The scalp block involves blocking six nerves that provide sensory innervation to the scalp. Segment 1: Blocks used in Head and Neck Surgeries In this episode, we will explore the various regional anesthesia techniques used in neurosurgery, specifically focusing on blocks for head, neck, and spinal surgeries.
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