Lumbar Total Dorsal Ramus Injection: Difference between revisions
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This is a procedure used to both all three branches of one or more dorsal rami.{{#pmid:17383923|miyakoshi}} This can be done under ultrasound guidance and so is more readily accessible than the preferred fluoroscopically guided medial branch block. See {{#l:kimura2020 ultrasound guided total dorsal ramus block.pdf|Kimura et al}} for a free open access article on the technique.<ref>Kimura ''et al''. Ultrasound-guided total dorsal ramus block for the treatment of chronic low back pain. Journal of Orthopaedics, Trauma and Rehabilitation. June 2020. [https://doi.org/10.1177/2210491720928505 DOI]</ref> | This is a procedure used to both all three branches of one or more dorsal rami, by injecting large volumes of local anaesthetic in the conventional area of the medial branch block.{{#pmid:17383923|miyakoshi}} This can be done under ultrasound guidance and so is more readily accessible than the preferred fluoroscopically guided medial branch block, and has there is no radiation exposure. | ||
See {{#l:kimura2020 ultrasound guided total dorsal ramus block.pdf|Kimura et al}} for a free open access article on the technique.<ref>Kimura ''et al''. Ultrasound-guided total dorsal ramus block for the treatment of chronic low back pain. Journal of Orthopaedics, Trauma and Rehabilitation. June 2020. [https://doi.org/10.1177/2210491720928505 DOI]</ref> | |||
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[[File:Lumbar-medial-branch-nerve-blocks2.jpg|thumb|right|AP View<br><small>Source unknown</small>]] | [[File:Lumbar-medial-branch-nerve-blocks2.jpg|thumb|right|AP View<br><small>Source unknown</small>]] | ||
==Anatomy== | ==Anatomy== | ||
The lumbar dorsal rami have three branches. The medial branch innervates the multifidus muscle and the facet joint at the same level and the level above. The intermediate branch innervates the longissimus muscles. The lateral branch innervates the iliocastalis muscle. | |||
==Indications== | ==Indications== | ||
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===Ultrasound Guided=== | ===Ultrasound Guided=== | ||
*Position: prone, with pillow under abdomen to decrease lordosis | |||
*Place convex ultrasound probe at the approximate fifth lumbar level | |||
*Identify the spinous, superior articular, and transverse processes | |||
*Target point is the junction of the L5 superior articular process and the transverse process | |||
*Aspirate to evaluate for vessel placement, then inject 5mL of local anaesthetic on one or both sides | |||
*During injection maintain cranial rotation of the needle bevel to maximise cranial spread of the injectate | |||
*Evaluate for pain at rest and during motion in maximum flexion and extension both before and 30 minutes after the block. A full pain diary can be completed. | |||
===Fluoroscopy Guided=== | ===Fluoroscopy Guided=== | ||
If there is fluoroscopic access then one should perform a standard medial branch block. | |||
===Landmark Guided=== | ===Landmark Guided=== |
Revision as of 15:30, 6 September 2020
Lumbar Total Dorsal Ramus Injection | |
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Indication |
This is a procedure used to both all three branches of one or more dorsal rami, by injecting large volumes of local anaesthetic in the conventional area of the medial branch block.[1] This can be done under ultrasound guidance and so is more readily accessible than the preferred fluoroscopically guided medial branch block, and has there is no radiation exposure.
See {{#l:kimura2020 ultrasound guided total dorsal ramus block.pdf|Kimura et al}} for a free open access article on the technique.[2]
Anatomy
The lumbar dorsal rami have three branches. The medial branch innervates the multifidus muscle and the facet joint at the same level and the level above. The intermediate branch innervates the longissimus muscles. The lateral branch innervates the iliocastalis muscle.
Indications
Contraindications
Pre-procedural Evaluation
Equipment
Technique
Ultrasound Guided
- Position: prone, with pillow under abdomen to decrease lordosis
- Place convex ultrasound probe at the approximate fifth lumbar level
- Identify the spinous, superior articular, and transverse processes
- Target point is the junction of the L5 superior articular process and the transverse process
- Aspirate to evaluate for vessel placement, then inject 5mL of local anaesthetic on one or both sides
- During injection maintain cranial rotation of the needle bevel to maximise cranial spread of the injectate
- Evaluate for pain at rest and during motion in maximum flexion and extension both before and 30 minutes after the block. A full pain diary can be completed.
Fluoroscopy Guided
If there is fluoroscopic access then one should perform a standard medial branch block.
Landmark Guided
Complications
Aftercare
Videos
See Also
External Links
References
- ↑ Miyakoshi et al.. Total dorsal ramus block for the treatment of chronic low back pain: a preliminary study. Joint bone spine 2007. 74:270-4. PMID: 17383923. DOI.
- ↑ Kimura et al. Ultrasound-guided total dorsal ramus block for the treatment of chronic low back pain. Journal of Orthopaedics, Trauma and Rehabilitation. June 2020. DOI
Literature Review
- Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf
- Articles from all years: PubMed search, Google Scholar search.
- TRIP Database: clinical publications about evidence-based medicine.
- Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,