No, It was just a comment that 1 of the anesthesiologists' made, and i don't think he realized the significance of my TOS. I wasn’t impressed with the the original anesthesiologist and I requested a consult someone else, and asked if he even knew anything about TOS and specific blocks to the area where I need it, and my history with unsuccessful surgery, symptoms etc, and he actually was able to get my referring Dr and do a consult in the room - to make sure all my questions/concerns were answered (suffice to say the 1st guy isn’t coming anywhere near me). I’m also more comfortable to say that he has done several blocks for patients with TOS.
Yes. it's the brachial plexus and phrenic nerve, using the ultrasound.
I will be awake, they're just slightly sedating me,
they mentioned the injections are sometimes in series of 6. They want to try me off with just 1 injection (for now), and see if it works, and if it's worth doing again. They’re going to use bupivicaine (?sp). in terms of how long it lasts… the dr said it depends, it can last anywhere from a couple weeks to a couple of months. we just have to “wait and see” after the first set of injections.
"re-do" surgery is my VERY last option, and here they more than likely won't do it because i have "pain". unless they see issues effecting on my vascular system (which recent scans showed "none") than again, they can't see scar tissue... and honestly.... i'd be even more hesitant to have it done....
Thanks again
Quote:
Originally Posted by Sea Pines 50
Whoa, Friend! This sounds risky to me, esp. if your doc is unfamiliar with TOS, as you say.
What nerve(s) are to be targeted? If you're talking about the brachial plexus and the phrenic nerve, or other inter scalene placement, please make absolutely sure they are going to use imaging by ultrasound, fluoroscopy (live x-ray) and/or CT scan to guide the physician in needle placement.
Will you be awake during the procedure, so that electrical stimulation can be used to provide feedback on the proximity of the needle to the target nerve(s)?
What kind of pain relief are you supposed to get from the nerve block(s)? How long will it (relief) last? I'm sure you have been advised of the dangers of permanent nerve injury involved with this procedure.
Also, what substance(s) will be injected (e.g., wydase, lidocaine, opioid, etc.). I know that Dr. Jordan used to do Wydase blocks of the brachial plexus (may still offer that, I'm just not sure)… but it makes me nervous - no pun intended! - that this seems to be so rarely performed, if at all, for TOS.
The blocks you will see discussed on this forum are all muscle blocks, as far as I can tell. Scalene, subclavius, pec minor, usually - the so-called "culprit" muscles in the TOS monster we all struggle with.
I know what you mean when you say you will do anything if it will address some of the pain and other issues your TOS is giving you. You've had a first rib resection; the next surgery (called a "re-do") is usually a complete scalenectomy. Have you had that? Lysis and neurolysis are typically performed at that time, as well as general clean-up of any scar tissue that has formed around the brachial plexus, the subclavian vein and the subclavian artery and environs. The anterior and middle scalene muscles are taken out completely, along with any remaining portion of the first rib (if it wasn't completely removed in the first op it can grow back!)
Certainly don't want to scare you, but when you said the anesthesiologist (I think) did not seem to know too much about TOS - and, did not even believe that nerve block(s) are going to help you… Well, I just had to jump in.
The risk/reward ratio maybe needs to be looked at a bit more closely before you go forward with this. I know we have others from Toronto on this board; maybe do a forum search and see if some of them mention the particular vascular surgeons, pain management specialists, neurologists, PT's, etc. they have found who are knowledgable about TOS, and then book one (or more) for a second opinion.
Just my 2 cents! I wish you the very best in your quest for relief and hope you can get some "sustainable results," as they say. If I were you, I would proceed with great caution here. Our poor nerves don't like to be poked!
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