Atlas of interventional pain management by Steven D. Waldman MD JD PDF

By Steven D. Waldman MD JD

ISBN-10: 0721675778

ISBN-13: 9780721675770

This atlas, a significant other to the preferred INTERVENTIONAL discomfort administration, presents step by step full-color illustrations demonstrating interventional ache administration innovations. Over 2 hundred computer-generated figures offer a vivid and colourful approach to view ache administration equipment in a nearly three-D method. The textual content deals concise info on anatomy, symptoms, process, and issues in an easy, bulleted layout.

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Because of the loose alveolar tissue of the eydid, a gauze sponge should be used to apply gentle pressure on the upper eyelid and supratrochlear tissues before injection of solution to prevent the injectate from dissecting inferiorly into these tissues. This pressure should be maintained after the procedure to avoid periorbital hematoma and ecchymosis. After gentle aspiration, 3 mL of solution is injected in a fanlike distribution. 39 • 40 Se c t ion - SIDE EFFECTSAND COMPLICATIONS The forehead and scalp are highly vascular, and the pain specialist should carefully calculate the total milligram dosage of local anesthetic that may be safely given, especially if bilateral nerve blocks are being performed.

The skin overlying the notch is prepared with antiseptic solution, with care being taken to avoid spillage into the eye. A 25-gauge, 1 V2inch needle is inserted at the level of the infraorbital notch and is advanced medially approximately 15 degrees off the perpendicular to avoid entering the foramen. The needle is advanced until it approaches the periosteum of the underlying bone (Fig. 11-2). A paresthesia may be elicited and the patient should be warned of such. The needle should not enter the infraorbital foramen, and should this occur, the needle should be withdrawn and redirected slightly more medially.

These complications can be decreased if manual pressure is applied to the area of the block immediately after injection. Application of cold packs for 20-minute periods after the block also decreases the amount of post-procedure pain and bleeding the patient may experience. Infraorbital nerve block is useful in the palliation of pain secondary to facial trauma and neuropathic pain involving the infraorbital nerve. For use in the pediatric population or for repair of facial lacerations, the intraoral approach to blockade of the infraorbital nerve should be considered.

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