1-Minute Lumbar Medial Branch Block

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Equipment

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Create a Pointer

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Draw up meds

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Prep Quincke Needle

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We'll treat L4, L5, sacral ala, then L3

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Get a scotty dog view of L4

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Find Insertion Point

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Anesthetize and direct to target

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Level off L5

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Redirect needle to L5

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Repeat steps 7 and 8...

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Repeat steps 7 and 8...

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Check a lateral

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One insertion point

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Little C-arm movement

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Lumbar Medial Branch Block

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1-Minute Lumbar Medial Branch Block

Equipment

Create a Pointer

Use the longest option that you have, here a 20cc syringe and needle are used (cap on to prevent pokes).

Draw up meds

Small syringe for subq lidocaine and larger syringe for injectate at each level.

Prep Quincke Needle

Use desired technique. A sharp angle is used here.

We'll treat L4, L5, sacral ala, then L3

We're treating in this order since all targets are accessible from an entry above L4

Get a scotty dog view of L4

Level off L4 (red), look down the facet joint (blue)

Find Insertion Point

The pointer is over the ideal insertion point, just lateral to the L4 SAP/TP junction.

Anesthetize and direct to target

Aim to contact bone at the L4 SAP/TP junction. Then inject medication

Level off L5

Tilt the C-arm (probably the top towards the head) to level off L5

Redirect needle to L5

From the L4 target, pull the needle out partially, aim inferior, direct till contacting bone at the L5 target. Inject.

Repeat steps 7 and 8...

Here, we repeat the steps for the sacral ala

Repeat steps 7 and 8...

Here, we repeat the steps for L3

Check a lateral

Often this isn't needed, but this can confirm depth and proper placement

One insertion point

Note the single insertion point on the skin for more patient comfort

Little C-arm movement

Usually 4 AP views and 1 lateral view are sufficient. 1 minute procedure time. NICE JOB!

Lumbar Medial Branch Block

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