Abstract

In Interventional Pain Management, we frequently perform procedures at multiple levels. For example, we often perform transforaminal epidural steroid injections (TESI) at two adjoining levels or middle branch nerve blocks (MBB) at three or four levels. The current technique is to perform an injection at one level, remove the needle, reposition the fluoroscope, and then reinsert the needle through the skin for the injection at the other level. However, skin needle penetration is painful. It takes extra time and increases radiation exposure with needle repositioning. Also, multiple skin penetrations increase the risk of infection [1]. I want to share my technique that allows multiple-level procedure performance with a single needle skin penetration. This is how it is done with L4-L5 TESI: