PainExam Podcast

David Rosenblum, MD
  • 4.1 (28)
  • MEDICINE
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PainExam Podcast

David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians. Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery. Available at Amazon.com and www.MyKidsSurgery.com

  1. PRP vs. BMAC for Knee, Spine and Shoulder Pain- Journal Club

    6 DAYS AGO

    PRP vs. BMAC for Knee, Spine and Shoulder Pain- Journal Club

    PainExam Podcast Show  Episode Title: Exploring PRP and BMAC in Pain Managemen  Host:   David Rosenblum, MD           Release Date:    November 27, 2024    Episode Overview:  In this episode of the PainExam Podcast, Dr. David Rosenblum, a New York-based pain physician, examines the latest research surrounding Platelet-Rich Plasma (PRP) and Bone Marrow Aspirate Concentrate (BMAC) in pain management for the knee, shoulder, and spine. Dr. Rosenblum reviews several key studies, providing insights into the efficacy of these regenerative treatments and their implications for clinical practice. Featured Studies:  1.  A Comparison of Functional Outcomes in Rotator Cuff Repairs Using Adjunctive Bone Marrow Aspirate Concentrate vs. Bone Marrow Aspirate Concentrate With Platelet-Rich Plasma: A Systematic Review and Meta-Analysis**      -     Authors:       Seth J. Spicer, Sara Soliman, Robert Malek, Mitchell Kaplan, Jensen Clark, Nicholas Averell, Brandon Goodwin, Richard Jermyn      -  Published in:  Cureus. 2024 Aug 23;16(8):e67594. doi: 10.7759/cureus.67594      -  Summary: This systematic review evaluates the outcomes of rotator cuff repairs (RCR) using BMAC alone versus BMAC combined with PRP. The analysis included three studies and found no significant difference in functional outcomes between the two groups, suggesting that BMAC alone may be adequate, potentially reducing costs and resource use. 2.        Bone Marrow Aspirate Concentrate Versus Platelet-Rich Plasma for Treating Knee Osteoarthritis: A One-Year Non-Randomized Retrospective Comparative Study            -  Authors: Abed El-Hakim El-Kadiry, Carlos Lumbao, Natasha Salame, Moutih Rafei, Riam Shammaa      -  Published in:  BMC Musculoskeletal Disorders, 2022.      -  Summary:   This study compared the effectiveness of intra-articular BMAC and PRP injections in patients with knee osteoarthritis (OA). Results indicated that patients receiving BMAC experienced significant improvements in pain and functionality scores over 12 months, while the PRP group showed nonsignificant improvements. BMAC was found to be more effective than PRP in managing knee OA symptoms. 3.  Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis**      -     Authors:  John W. Belk, Joseph J. Lim, Carson Keeter, Patrick C. McCulloch, Darby A. Houck, Eric C. McCarty, Rachel M. Frank, Matthew J. Kraeutler      -       Published in:   World Journal of Stem Cells, 2021.      -    Summary:  This systematic review assessed the efficacy of PRP and BMAC compared to hyaluronic acid (HA) injections for knee OA. The findings demonstrated that both PRP and BMAC led to significantly better patient-reported outcomes (PROs) compared to HA, with no significant differences between PRP and BMAC in terms of effectiveness. 4.          Platelet-Rich Plasma vs Bone Marrow Aspirate Concentrate: An Overview of Mechanisms of Action and Orthobiologic Synergistic Effects             - Authors: José Fábio Santos Duarte Lana, Lucas Furtado da Fonseca, Rafael da Rocha Macedo, Tomas Mosaner, William Murrell, Ashok Kumar, Joseph Purita, Marco Antonio Percope de Andrade      -  Published in:  World Journal of Stem Cells, 2021.      - **Summary:** This overview discusses the mechanisms of action for PRP and BMAC and their potential synergistic effects in musculoskeletal healing. The authors highlight that while both therapies show promise, further research is needed to standardize treatment protocols and fully understand their combined effects on healing processes. 5.  PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers*       -   Authors:       Fabio S. M. Yamaguchi, Shahin Shams, Eduardo A. Silva, Roberta S. Stilhano      -

    22 min
  2. Optimizing Genicular Ablation with Phenol- Journal Club!

    NOV 14

    Optimizing Genicular Ablation with Phenol- Journal Club!

    Podcast Show Notes Episode Title: Optimizing Genicular Nerve Chemical Ablation: Insights from Dr. David Rosenblum Episode Summary: In this episode, we are joined by Dr. David Rosenblum, a New York-based interventional pain physician, who discusses optimizing genicular nerve chemical ablation. Dr. Rosenblum shares insights as well as his upcoming ultrasound course schedyke in New York City, focusing on regional anesthesia, interventional pain, and IV ultrasound placement. He emphasizes the significance of ultrasound in enhancing pain management procedures and the latest advancements in the field. Key Topics Discussed: Overview of Dr. Rosenblum's upcoming ultrasound courses in NYC, including regional anesthesia and IV ultrasound placement. More information can be found here or at NRAPpain.org. The role of ultrasound in interventional pain management, specifically in optimizing genicular nerve chemical ablation. Discussion on the recent study comparing genicular nerve phenol neurolysis and radiofrequency ablation. Importance of updating anatomical targets for pain management. Recommendations for expanding the number of targets in pain interventions. Insights on the safety and efficacy of chemical neurolysis versus radiofrequency procedures. Challenges and considerations in performing neurolytic blocks. Future directions in personalized treatment for chronic pain patients. Featured Article: Dr. Rosenblum references an article from The Korean Journal of Pain discussing the optimization of genicular nerve chemical ablation. Key takeaways include: The evolution of anatomical understanding related to genicular nerves. The recommendation to consider multiple targets for pain management instead of the traditional three. The need for careful patient examination to map pain effectively before intervention. Discussion on Knee Pain Management • ArticlebyAndresRochaRomero: • Discussion on knee pain targeting genicular nerve ablation. • Co-authored by Tony Ng and King K Stanley Lam. • Published in Korean Journal of Pain. • Highlights differences in pain management practices outside the U.S. Other Points on Genicular Nerve Chemical Ablation discussed Phenol ablation being used more internationally vs. radiofrequency ablations. Considerations for more extensive targeting of genicular nerves: • Importance of the median branch of the nerve to the vastus intermedius. • Expansion of targeting to include 6 nerves, not just 3. • Anatomical variations require different approaches. Recommendations and Observations • Importance of considering patient-specific anatomy and pain. • Repeat procedures and rehabilitation: • Concerns about bio intensity and fascia integrity. • Emphasizes muscle strengthening exercises to support knee. • CRPS Considerations: • Elderly patients may develop CRPS post-knee replacement. • Importance of lumbar sympathetic block in diagnosis and treatment. Host Bio: Dr. David Rosenblum, MD is an interventional pain physician based in New York City. With extensive experience in pain management techniques, Dr. Rosenblum is dedicated to advancing the field through education and innovative practices. He is particularly focused on the integration of ultrasound technology into pain management procedures. Course Information: Dr. Rosenblum's upcoming ultrasound courses are CME supported, monthly hands on workshops to give clinicians experience with ultrasound imaging to identify targets for nerve block joint injection, soft tissue injection and more.. • Monthly IV Ultrasound Course in Manhattan: • Ideal for nurses, PAs, anesthesiologists, ER docs. • Provides practice with phantoms, short lecture on IV ultrasound. • Offers CME credits. • Ultrasound Courses: • Held one Saturday a month, mostly in New York, but travels if needed. • Upcoming dates: December 21st, January 11th in Manhattan. • Presentation Invitation at Pain Expo in Dubai:

    18 min
  3. Multifidus Atrophy: Multifidus Stimulation, Peripheral Nerve Stimulation & Leukocyte Rich PRP

    OCT 25

    Multifidus Atrophy: Multifidus Stimulation, Peripheral Nerve Stimulation & Leukocyte Rich PRP

    Exploring the Efficacy of Autologous Platelet Leukocyte Rich Plasma Injections in Chronic Low Back Pain & Understanding Degenerative Lumbar Spinal Stenosis  Host David Rosenblum, MD  Episode Date: October 25, 2024 In this episode, Dr. David Rosenblum discusses two significant studies related to chronic low back pain and degenerative lumbar conditions. The first study focuses on the use of autologous platelet leukocyte rich plasma (PLRP) injections for treating atrophied lumbar multifidus muscles, while the second study investigates the correlation between muscle atrophy and the severity of degenerative lumbar spinal stenosis (DLSS).  Featured Article 1:  - Effect of Autologous Platelet Leukocyte Rich Plasma Injections on Atrophied Lumbar Multifidus Muscle in Low Back Pain Patients with Monosegmental Degenerative Disc Disease - **Authors:** Mohamed Hussein, Tamer Hussein    Key Points Discussed  1. Background:  Correlation between lumbar multifidus muscle dysfunction and chronic low back pain. 2.  Study Overview: 115 patients treated with weekly PLRP injections for six weeks, followed for 24 months. 3.  Outcome Measures:  Significant improvements in NRS and ODI scores, with high patient satisfaction. 4. Conclusions: PLRP injections into the atrophied multifidus muscle are safe and effective for managing chronic low back pain.  Featured Article 2:  -   Degenerative Lumbar Spinal Stenosis  Authors:*  Gen Xia, Xueru Li, Yanbing Shang, Bin Fu, Feng Jiang, Huan Liu, Yongdong Qiao  Key Points Discussed  1. Background:  DLSS is a common condition in older adults, often leading to muscle atrophy and disability. 2. Study Overview: A retrospective analysis involving 232 patients to investigate the correlation between muscle atrophy and spinal stenosis severity. 3.  Results:     - Significant differences in the ratio of fat-free multifidus muscle cross-sectional area between stenotic and non-stenotic segments.    - A strong positive correlation was found between multifidus atrophy and the severity of spinal stenosis.    - The atrophy was more pronounced on symptomatic sides of the spine compared to contralateral sides. 4.  Conclusions:  The findings suggest that more severe spinal stenosis is associated with greater muscle atrophy, emphasizing the importance of addressing muscle health in DLSS patients.  Discussion:  Dr. Rosenblum provides insights into how these studies inform clinical practices for treating chronic low back pain and managing degenerative conditions. He emphasizes the need for comprehensive treatment strategies that consider both muscle health and spinal integrity which may be achieved via peripheral nerve stimulation of the medial branch nerve and multifidus muscle or PRP injection in to the multifidus muscle.  Closing Remarks:  Listeners are encouraged to stay informed about innovative treatment options and the importance of muscle assessment in managing spinal disorders.   **Follow Us:** - Subscribe to the Painexam Podcast for more episodes discussing the latest in pain management research and treatments. - Connect with us on social media [insert social media links]. NRAP Academy also offers: Board Review Anesthesiology Pain Management Physical Medicine and Rehabilitation Regenerative Medicine Training  Live Workshops Online Training The Virtual Pain Fellowship (online training program with discount to live workshops)         Regional Anesthesia & Pain Ultrasound Course   Private Training Available Email Info@NRAPpain.org **Disclaimer:** The information presented in this podcast is for educational purposes only and should not be considered medical advice. Always consult a healthcare professional for medical concerns. References Xia, G., Li, X., Shang, Y. et al. Correlation between severity of spinal stenosis and multifidus atrophy in degenerative lumbar spinal stenosis. BMC Musculoskelet Disord 22, 536 (2021).

    25 min
  4. Scrambler Therapy for Neuropathic Pain: Efficacy and Mechanism of Action

    OCT 9

    Scrambler Therapy for Neuropathic Pain: Efficacy and Mechanism of Action

    Dr. Rosenblum reviews the benefits of Scrambler Therapy for CRPS and Neuropathic Pain State.  What is Scrambler Therapy? Efficacy of Scrambler Therapy for Neuropathic Pain  Mechanism of action of Scrambler Therapy Regenerative Pain Management Course PainExam Board Prep NRAP Academy Private Tutorials for Ultrasound Guidance and Regenerative Medicine ST was introduced as a chronic pain relief method in 2003. That same year, Giuseppe Marineo published findings from a small clinical trial involving 11 terminal cancer patients suffering from drug-resistant chronic visceral pain, with all participants showing positive responses and significant reductions in pain scores. In a subsequent trial involving 226 patients with neuropathic pain, 80% reported a 50% reduction in pain. Since then, numerous case reports and studies have documented the use of ST for various pain types. Evidence from these reports suggests that ST is effective for managing both acute and chronic pain from different causes. For instance, a child with acute mixed pain, resistant to pharmacological treatment, experienced significant relief after four ST sessions, with pain levels dropping from 5/10 to 0/10. Additionally, a 52-year-old woman with burning pain from her foot to knee, stemming from a right medullary acute hemorrhage and suffering for 12 years, reported immediate relief after ST. Her pain score decreased from 9/10 to 3/10 on the first day, and to 0/10 by the second day, remaining below 1 on the Visual Analog Scale (VAS) throughout the 10-day treatment period. In terms of chronic pain, literature includes a case where a patient with shoulder joint pain and limited range of motion saw significant pain reduction and increased mobility after 10 sessions of ST. ST has shown considerable promise in treating severe pain conditions that are typically difficult to manage, such as complex regional pain syndrome and pain related to HIV. Despite the encouraging results from these case studies, higher-quality evidence is necessary to establish the efficacy of ST, which could be obtained through extensive clinical trials, particularly focusing on chronic pain. Besides the aforementioned studies by Marineo and Sabato et al, additional trials have indicated that ST is an effective treatment for various chronic pain conditions, including low back pain, postherpetic pain, and neuropathic pain. For instance, a prospective study on chronic low back pain patients showed a significant decrease in VAS scores from 8.12 to 3.63 after six treatment days. Another trial involving 10 patients with postherpetic pain reported a drop in the average Numeric Rating Scale (NRS-11) score from 7.64 to 1.46 at baseline and 0.42 to 0.89 after one month, with benefits persisting at two and three months. ST has also demonstrated significant potential in treating neuropathic pain. In a prospective study of 45 patients with neuropathic pain lasting over three months, 28 experienced a decrease in Douleur Neuropathique en 4 questions (DN4) pain scores, with four patients stopping treatment early due to complete pain resolution. The mean baseline DN4 score dropped from 5.67 to 2.82 by the end of treatment. A pilot randomized trial involving 52 patients found that 21 out of 26 in the intervention group achieved complete pain relief. While the findings from these studies, along with others that have been systematically analyzed, suggest strong evidence for the efficacy of ST, a definitive conclusion regarding its effectiveness has not yet been reached. A systematic review by Majithia et al concluded that while studies generally indicate ST results in pain reduction with lasting benefits, there are still gaps in the evidence. This article aims to evaluate the research needs surrounding ST for cancer pain management. While Majithia et al focused on chronic pain across various conditions and noted specific evidence limitations, this study will concentrate on the effectiveness of ST for cance

    17 min
  5. Using Molecular Hydrogen an Analgesic?

    SEP 12

    Using Molecular Hydrogen an Analgesic?

    PainExam Podcast Episode: An In-Depth Look at Hydrogen-Rich Water for Chronic Inflammatory Pain In a recent episode of the PainExam podcast, Dr. David Rosenblum delves into an intriguing study published in the journal Antioxidants, exploring the therapeutic potential of hydrogen-rich water (HRW) in alleviating chronic inflammatory pain and associated mood disorders in mice. The study, conducted by Santiago Coral-Pérez and colleagues from the Institut d’Investigació Biomèdica Sant Pau and Universitat Autònoma de Barcelona, presents compelling evidence supporting the analgesic, antidepressant, and anxiolytic effects of HRW. Study Overview The study investigates the efficacy of HRW in treating nociceptive responses and affective disorders associated with chronic inflammatory pain. Using a mouse model induced by the subplantar injection of complete Freund's adjuvant (CFA), the researchers evaluated the impact of HRW on several parameters: Nociceptive Responses: Mechanical allodynia and thermal hyperalgesia. Affective Disorders: Depressive-like behaviors (measured by Tail Suspension Test and Forced Swimming Test) and anxiety-like behaviors (assessed using Elevated Plus Maze and Open Field tests). Biomarker Analysis: Levels of oxidative stress, inflammatory, and apoptotic markers in the paws and amygdala. Key Findings 1. Analgesic Effects: Mechanical Allodynia and Thermal Hyperalgesia: The study found that both intraperitoneal and subplantar administration of HRW significantly reduced mechanical allodynia and thermal hyperalgesia in CFA-injected mice. Remarkably, the local (subplantar) administration showed greater effectiveness, achieving complete inhibition of nociceptive responses with just one day of treatment. 2. Antidepressant and Anxiolytic Effects: Depressive-like Behaviors: HRW treatment normalized the increased immobility times in both the Tail Suspension Test and Forced Swimming Test, indicating potent antidepressant properties. Anxiety-like Behaviors: HRW also reversed the anxiety-like behaviors in the Elevated Plus Maze and Open Field tests, showcasing its anxiolytic effects without impairing motor function. 3. Biochemical Pathways: The study highlighted the significant role of the Nrf2/HO-1-NQO1 pathway in mediating the analgesic effects of HRW. Inhibitors targeting this pathway reversed the pain-relieving actions of HRW, underscoring its pivotal role. Oxidative Stress and Inflammation: HRW treatment reduced the expression of oxidative (4-HNE), inflammatory (p-IKBα), and apoptotic (BAX) markers in both the paw and amygdala tissues, demonstrating its broad-spectrum protective effects. Implications for Clinical Practice Dr. Rosenblum emphasizes the potential of HRW as a novel therapeutic strategy for chronic inflammatory pain and its associated comorbidities. The study's findings suggest that HRW could offer a multifaceted approach, addressing both pain and mood disorders through its antioxidant, anti-inflammatory, and anti-apoptotic properties. Conclusion The episode concludes with a discussion on the broader implications of these findings for pain management, particularly in conditions where chronic inflammatory pain is prevalent. Dr. Rosenblum highlights the need for further clinical trials to validate these promising preclinical results and explore the potential of HRW in human subjects. For more detailed insights into this study, including potential applications and future research directions, tune into the PainExam podcast with Dr. David Rosenblum. For more information go to: https://molecularhydrogeninstitute.org/links-mhi/ Other Announcements from NRAP Academy: PainExam App is ready for iphone    Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org   Live Workshop Calendar       Ultrasound Interventional Pain Course Registration    For Anesthesia Board Prep Cli

    11 min
  6. Safe and Accurate PRP Injections Using Ultrasound - AMETD Lecture 2024- IASP Mexican Chapter, Mexico City

    AUG 19

    Safe and Accurate PRP Injections Using Ultrasound - AMETD Lecture 2024- IASP Mexican Chapter, Mexico City

    Dr. Rosenblum serves at AMETD's 2024 Conference as faculty and discusses the safe and accurate usage of Ultrasound to Guide PRP injecitons Discussed in this lecure: Knee, Hip, Shoudler, Ligament and Tendon Targets, the ultrasound technique, the evidence for PRP and controversy.  Controversy with respect to the Achilles Tendon! Other Announcements from NRAP Academy: PainExam App is ready for iphone    Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org   Live Workshop Calendar       Ultrasound Interventional Pain Course Registration    For Anesthesia Board Prep Click Here! References  https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdf Disclaimer Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is  for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user’s own risk. Professionals should conduct their own fact finding, research, and due diligence to come to their own conclusions for treating patients. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professionals for any such conditions.

    19 min
  7. New Guidelines for Corticosteroid Injections in Chronic Pain Management

    JUL 31

    New Guidelines for Corticosteroid Injections in Chronic Pain Management

    Podcast Show Note Summary: Episode Title: "New Guidelines for Corticosteroid Injections in Chronic Pain Management" This podcast is a discussion about the recent review article Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society In this episode, we dive into the recently published guidelines on the use of corticosteroid injections for managing chronic pain, developed by the American Society of Regional Anesthesia and Pain Medicine, along with several other prominent pain societies. These guidelines address the safety and efficacy of corticosteroid injections for sympathetic and peripheral nerve blocks, as well as trigger point injections. Key Discussion Points: Background and Need for Guidelines: Overview of potential adverse events from corticosteroid injections, such as increased blood glucose levels, decreased bone mineral density, and suppression of the hypothalamic–pituitary axis. Importance of using lower doses of corticosteroids, which studies have found to be just as effective as higher doses. Development of the Guidelines: The guidelines were approved by multiple pain societies and structured into three categories: sympathetic and peripheral nerve blocks, joint injections, and neuraxial injections. Extensive literature review and consensus-building through a modified Delphi process. Key Recommendations: The addition of corticosteroids to local anesthetics is recommended for certain nerve blocks, such as the greater occipital nerve block for cluster headaches and ilioinguinal/iliohypogastric nerve blocks for post-herniorrhaphy pain. Corticosteroid addition is not recommended for sympathetic nerve blocks, greater occipital nerve blocks for migraines, and pudendal nerve blocks for pudendal neuralgia. Imaging guidance (ultrasound or fluoroscopy) improves the safety and accuracy of certain procedures. Efficacy and Safety: Detailed analysis of various studies on the effectiveness of corticosteroid injections for different types of chronic pain. Discussion on the minimal benefit of corticosteroids in trigger point injections and the potential risks associated with their use. Clinical Implications: How these guidelines can assist clinicians in making informed decisions regarding corticosteroid use in chronic pain management. Emphasis on the need for personalized treatment plans based on individual patient characteristics and clinical data. Future Directions: Identification of gaps in the current research and the need for well-designed studies to further assess the benefits and risks of corticosteroid injections. Join us as we explore these comprehensive guidelines and their potential impact on improving chronic pain management practices. Resources: Link to the full guidelines: Journal Online Other Announcements from NRAP Academy: PainExam App is ready for iphone    Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org   Live Workshop Calendar       Ultrasound Interventional Pain Course Registration    For Anesthesia Board Prep Click Here! References  https://rapm.bmj.com/content/rapm/early/2024/07/16/rapm-2024-105593.full.pdf Disclaimer Disclaimer: This Podcast, website and any content from NRAP Academy (NRAPpain.org) otherwise known as Qbazaar.com, LLC is  for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of inf

    19 min
  8. Trigeminal Nerve Block for Cancer: Ultrasound and Flouro Approaches

    JUL 19

    Trigeminal Nerve Block for Cancer: Ultrasound and Flouro Approaches

    PainExam Show Notes: Mandibular Division of the Trigeminal Nerve Block with Dr. David Rosenblum VIsit the NRAP Academy for the PainExam Board Prep! Introduction Host: Dr. David Rosenblum Topic: Mandibular Division of the Trigeminal Nerve Block for Cancer Pain Management Techniques: Ultrasound and Fluoroscopic Guidance Overview Purpose: Alleviate chronic facial pain, specifically in cancer patients suffering from trigeminal neuralgia or other related conditions. Focus: Detailed discussion on the anatomy, clinical presentation, and procedural techniques for effective nerve block. Anatomy of the Mandibular Nerve Origin: Mandibular nerve is a branch of the trigeminal nerve (cranial nerve V). Pathway: Exits the middle cranial fossa through the foramen ovale and descends between the lateral and medial pterygoid muscles. Sensory Innervation: Anterior two-thirds of the tongue Teeth and mucosa of the mandible Skin of the chin and lower lip Skin over the mandible (excluding the mandibular angle) Tragus and anterior part of the ear Posterior part of the temporalis muscle up to the scalp Ultrasound-Guided Technique Patient Positioning: Patient lies on their side with the affected side facing upward. Transducer Selection: Curvilinear transducer preferred for deeper structures. Transducer Placement: Place distal and parallel to the zygomatic arch to bridge the coronoid and condylar processes. Anatomical Landmarks: Identify the lateral pterygoid muscle and plate. Use power Doppler to locate the sphenoid palatine artery. Needle Trajectory: Introduce the needle using an out-of-plane approach to target the pterygopalatine fossa (anterior to the lateral pterygoid plate). For the mandibular nerve block, target the area posterior to the lateral pterygoid plate between the medial and lateral pterygoid muscles. Electrostimulation (Optional): Utilize a 22G, 10 cm insulated short beveled needle connected to a peripheral nerve simulator. Position confirmed by motor response from the temporalis and masseter muscles. Fluoroscopic-Guided Technique Patient Positioning: Similar to ultrasound guidance, patient lies on their side with the affected side facing upward. C-arm Positioning: Position the C-arm to visualize the foramen ovale. Needle Insertion: Insert the needle under fluoroscopic guidance towards the foramen ovale. Contrast Injection: Confirm needle placement with contrast injection. Anesthetic Administration: Administer local anesthetic and/or neurolytic agents. Clinical Symptoms and Diagnosis Symptoms: Unilateral sharp, stabbing, or burning pain in the mandibular nerve distribution. Pain triggered by activities such as eating, talking, washing the face, or cleaning the teeth. Diagnostic Imaging: MRI or CT scans to identify causes like vascular compression, mass lesions, or fractures. Complications and Considerations Potential Complications: Bleeding, hematoma, infection, and hypersensitivity reaction to the injectate. Serious complications from neurolytic agents like permanent sensory deficit and tissue necrosis. Alternative Treatments: PNS? Radiofrequency or cryoablation for recalcitrant cases. Conclusion Efficacy: Ultrasound and fluoroscopic guidance provide precise targeting of the affected nerves, minimizing collateral damage. Safety: Routine use of power Doppler imaging to avoid injury to surrounding vessels. Recommendation: Consider these techniques for patients unresponsive to oral medications or unsuitable for surgery. These show notes provide a comprehensive overview of the discussion, highlighting key points on the anatomy, technique, and clinical considerations for mandibular nerve blocks in cancer patients. Other Announcements from NRAP Academy: PainExam App is ready for iphone    Pain Management Board Prep migrated to NRAPpain.org AnesthesiaExam Board Prep migrated to NRAPpain.org PMRExam Board Prep migrated to NRAPpain.org   Live

    17 min
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Ratings & Reviews

4.1
out of 5
28 Ratings

About

David Rosenblum, MD, creator of PainExam.com and Director of Pain Management at New York Based, AABP Pain Management discusses Pain Board Review and issues relevant to pain physicians. Marketing, practice management and Board Prep are discussed. For more information and CME Credit's go to PainExam.com Also, be sure to check out Dr. Rosenblum's children's book: Welwyn Ardsley and the Cosmic Ninjas: Preparing your child and yourself for anesthesia and surgery. Available at Amazon.com and www.MyKidsSurgery.com

Information

  • Creator
    David Rosenblum, MD
  • Years Active
    2015 - 2024
  • Episodes
    315
  • Rating
    Clean
  • Copyright
    © QBazaar.com LLC, Copyright 2015
  • Show Website
    PainExam Podcast

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