Interlaminar lumbar epidural block
by Baheti Dwarkadas K, Bakshi Sanjay, Gupta Sanjeeva, Gehdoo Raghbir Singh

Interventional Pain Management: A Practical Approach

by Sanjay Bakshi, Sanjeeva Gupta, Dwarkadas K Baheti, Raghbir Singh P Gehdoo
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This video presents the technique of a transforaminal epidural injection. The patient is placed prone on the fluoroscopy table. It is advisable to place a small pillow under the lower abdomen to open up the interlaminar space. At this point the skin is prepped and draped in a sterile fashion. After carefully identifying the appropriate interlaminar space that you want to enter using fluoroscopy, make a skin mark over the lamina below the target interspace. The skin and subcutaneous tissues are now anesthetized using 1% lidocaine. A 20G tuohy needle is now advanced to the lamina. It is preferable to contact the superior border of the lower lamina so that you have perception of the appropriate depth. The needle can now be walked off the lamina till it is felt to enter the ligamentum flavum. At this point attach a “loss of resistance” syringe to the needle. Depending on operator preference you can either use saline or air for the loss of resistance technique. Carefully advance the needle in small increments till you feel the loss of resistance on entering the epidural space. Once the epidural space is entered 1–2 cc of radio contrast dye is injected and the dye spread is visualized under continuous fluoroscopy in the anteroposterior (AP) position. The C-arm is now rotated to the lateral position and appropriate dye spread is reconfirmed in the lateral position. The dye spread should be in the epidural space and there should be no intravascular or intrathecal flow patterns. It is advisable to save the hard copy of the dye spread patterns in both AP and lateral views.

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