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!