Interventional Pain Management

Question 1

Superior hypogastric block improves pain in which areas? What type of pain?

Answer 1

Peritoneum
Genitals
Useful for GYN cancer

Pain that is REFRACTORY to medical management

Good for VISCERAL pain
This is a SYMPATHETIC block

Question 2

Stellate ganglion block improves pain in which areas? What type of pain?

Answer 2

Neck
Good for VISCERAL pain
This is a SYMPATHETIC block

Question 3

Ganglion pars block improves pain in which areas? What type of pain?

Answer 3

Pelvic but back towards rectum
Good for VISCERAL pain
This is a SYMPATHETIC block

Question 4

Brachial plexus block helps with pain in which areas? What type of pain?

Answer 4

Breast- useful post mastectomy

Good for FOCAL pain
Somatic block

Question 5

Gasserian ganglion block helps with pain in what areas?

Answer 5

Trigeminal nerve

Method of LAST resort- lowest risk for adverse side effects

This is for FOCAL pain
Somatic block

Question 6

What block may be first line medical management?

Answer 6

Celiac plexus block (sympathetic block)
for upper abdominal/pancreatic cancer

Side effects: hypotension/orthostasis, diarrhea

Question 7

Lumbar subarachnoid block indication

Answer 7

Unilateral leg pain

Question 8

Phenol saddle block indication

Answer 8

Pelvic pain

Question 9

Pudendal nerve block indication

Answer 9

Chronic pelvic pain (interstitial cystitis)

Question 10

Intercostal nerve block indication

Answer 10

Chest wall pain, metastatic breast cancer, rib lesions

Question 11

Medial branch block is in what location? Indication?

Answer 11

Block of medial branch of primary dorsal ramus which innervates facet joints of spine

Useful for intractable pain (malignant vertebral compression fractures)

Question 12

Prognosis required for epidural pain pump? Complications?

Answer 12

Must have life expectancy is DAYS TO WEEKS

Uses higher dose of medications than intrathecal pumps (more complications)

Higher risk of CATHETER FIBROSIS

Requires frequent pump refills

Question 13

Prognosis requires for intrathecal pain pump?

Answer 13

Must have life expectancy weeks to months

Appropriate for patients on >100 MEQ with refractory pain

Lower risk of catheter fibrosis and uses LOWER doses of medications (limits side effects)

Question 14

Possible side effects of medications used in Neuraxial Blocks?

Answer 14

Side Effects
- Morphine: Catheter tip granuloma
- RESPIRATORY DEPRESSION (rare)
- Bupivicaine: urinary retention, paresthesia, LE weakness, gait impairment, orthostatic hypotension (EMERGENCY!)
- Ziconotide: Psychosis

Question 15

Possible complications of intrathecal pain pump placement? (6)

Answer 15

Spinal cord injury/nerve injury- EMERGENCY
CSF leak
Infections
Migration, fracture of catheters
“Pump dump” with release of large concentrations of analgesia
Formation of granulomas

Question 16

Morphine conversion from IV to epidural to intrathecal

Answer 16

10 mg IV= 1 mg epidural= 0.1 mg intrathecal

Ratio from IV to IT is 1:100 (10 mg to 0.1 mg)

Question 17

When to use a medial branch block rather than kyphoplasty?

Answer 17

Epidural disease
Neurologic damage related to vertebral fracture
Fracture with BONE FRAGMENT extension into spinal canal
Infection
Severe cardiopulmonary disease
Hyper-coagulable state

Question 18

Timeline for pain improvement after XRT?

Answer 18

Pain relief typically in 2-4 weeks

Question 19

St. John’s Wort- interference/SE? (3 interactions)

Answer 19

Interferes with metabolisms of opioids
Interacts with blood thinners
Increases risk of SS

Question 20

Alpha lipoic acid- interference/SE?

Answer 20

Used for diabetic neuropathy and cancer prevention

Risk of HYPOGLYCEMIA and arrythmia

Question 21

Chondroitin- interference/SE?

Answer 21

Used for joint pain

Interferes with metabolism of blood thinners and opioids

Question 22

Turmeric- interference/SE? (5 major bad things)

Answer 22

Used as anti-inflammatory and fibromyalgia, OA

Causes GERD, iron deficiency, bleeding (slows clotting)

Can cause hypoglycemia
Interferes with oncology TX and anticoagulants

Question 23

Ginger- interference/SE? (4)

Answer 23

Increases blood glucose
Increases bleeding risk
Can affect heart at high doses
Interacts with coumadin

Question 24

Devil’s Claw- interference/SE?

Answer 24

Affects BP
Increased PUD risk
Hypoglycemia
Interacts with coumadin
Diarrhea, headache, anorexia, nausea

Question 25

Black licorice- interference/SE?

Answer 25

Causes hyper aldosteronism (low K, high Na), hypertension, swelling, fatigue, nausea, muscle cramps