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ESI's A New Era ? or Am I living in the past??

dilaurodilauro ConnecticutPosts: 9,856
edited 06/11/2012 - 8:54 AM in Spinal Injections
Today, I had one of my upteen ESI's. This was my first one since 2006/7, so I was pretty much prepared going in from what I assumed it to be... WRONG

- No food/water 12 hours before procedure
- Procedure performed in an operating like environment
- Slightly sedated
- Constant monitoring of vital signs
- Needle assisted by fluoroscope, entire procedure 30 minutes
- Brought out to a recovery room
- Waited about 30 minutes before leaving
- Required a driver

- No diet restrictions
- Procedure performed in doctors office (more than just a table)
- Area numbed, no sedation
- No monitoring of vital signs
- Needle assisted by fluoroscope, entire procedure 10 minutes (much less time)
- Off the table out the door (still no driving, but why?)

I spoke to this doctor in depth about all of these changes. He told me, that basically, it was insurance policies and rules that made all these changes.

- Insurance will not cover patient sedation. If this is required, an anesthetist needs to come in and the patient will be required to pay for those charges.
- EOB (Doctor charges) apprx average $108 today, $1,200 several years ago.
- Lack of sedation means many patients experience more discomfort and pain the first 24 hours.
- One good thing, Insurance companies are also beginning to disallow doctors from performing procedure without fluoroscope assistance.

Ok, so the bottom line....
In his estimation have these changes had any impact on the over all success of ESI;s??

(Luckily, this is another doctor I've know for almost 10 years, so, I know I am getting no run-around)

No , not really, I am still seeing more success with lower lumber ESI's then other spinal areas. Plus, with the insurance changes, there has been some backing off the 3 ESIs per year. Now, they can be done more often, which many times can result in better results.

Wow, this was an eye opener for me... I gotta start catching up on some newer technique and procedures

Ron DiLauro Spine-Health System Administrator
I am not a medical professional. I comment on personal experiences
You can email me at: rdilauro@veritashealth.com


  • I've never had sedation for any of the injections I've had, ESIs included. However there is more to the 'three a year' than insurance alone, as there are risks involved with the medication used in ESIs, and too much of a good thing isn't generally a good thing in many areas, where certain medications/chemicals are involved.
  • but do get the B/P checked during the ESI but not after and free to go when I feel alright to but no driving. I also had 6 ESIs last year instead of the normal 3.

    All of the injections are covered in Ontario where I live but last PM Dr. I had to buy my steroid and numbing agent by prescription but was reimbursed because I have a drug plan. I just wished I could get some pain relief from the injections and choose not to have anymore this year after 3 years and 3 PM Drs and 20-40% of only a few weeks of relief. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • Ron,

    Your description of the ESI is about the same as my experience. I really like the idea of quick and fast and out the door. I have had them that way for both Lumbar and Cervical. Now I have driven after a cervical but different doctor let me do it. Which of course I am fine to drive after the injections, so it is the only part I dislike. Actually my cousin usually takes me and sense I have a Sam's card, we head there afterwards, the numbness is welcome relief from the pain. Plus he carries everything for me in the house.

    Anyway I hope you get some welcome relief with this injection. Oh my doctor did say he can get 4 in during the course of a year, if the a few months have passed sense one.
  • I've had 2 ESIs now, sedation for both. Glad I did after I felt the jolt at the end of my 1st.

    As for eating restrictions--I learned the hard way about fasting before the procedure. I didn't eat lunch before my 1st & when I got home, I was insanely ravenous. Like nothing I've ever felt before. (Luckily, the first thing I found was a spinach salad. You can shovel a lot of spinach in w/o much damage).

    The next one, I ate my typical light lunch & had no such hunger spike afterward.
  • I'm usually sedated. The only one I wasn't sedated for was a medial branch block that didn't work. It is also performed in a surgical setting, recovery and all. I'm not allowed to eat or drink 6 hours before the shots. It depends on the shot they are giving if they hook me up to all the monitors. The last one they put me on all those, good thing they hadn't sedated me yet because my heart rate was around 52. That's normal for me but they were freaking out about it being so low. Insurance hasn't complained about them yet.
  • No food for 12 hours, sedated, vitals monitored, done in operating room, procedure performed under flouroscopy,recovery post procedure, had to have a driver.
    This has been the standard for every ESI I have had.
  • Hi Ron,

    I just had an ESI at C5/6 yesterday. My situation was fasting for 6 hours prior, performed in the doctors office in a surgical setting, pulse and bp monitored, dye, x-ray, doctor, nurse, and radiology tech present, followed by 30min or more recovery and driving restriction.

    One Love,

  • I, like you, have had too many to count dating back to '06!

    All of mine have been under sedation and all covered by private insurance with an average co-pay of about $80-100.00.

    A few were done in an operating/procedure type suite in the anethesiologist office.

    After my fusion I had my first one 6 months later. I felt I had been such a burden to others for so long. I knew I was to have a driver, but I'd had SO many I drove myself there and then plannned to take a taxi home.

    Epic Fail!! When they went to stand me up afterwards and thankfully they followed procedure and had 2 nurses, I couldn't weightbear on my legs at all! Down I went, caught by the nurses.

    It was hours before I could weight bear and stand. They almost admitted me.

    Please use my experience! Whether or not where you obtain your injections follows "best practice" it is in place for a reason. Please have someone with you!

    Wishing all the very best!
  • Due to me being a little paranoid about things going on behind my back, I opt for the sedation. Safer for the doc that way @)

    All of mine have been done with a fluoroscope and a quasi-surgical setting. But I do like it that my PM doc likes that same radio station as I do and has no problem with the radio being up a little to loud while he is working <:P
    View my history for all the gory details.
  • They have changed a bit over the years. My last one was in 08 at an outpatient surgical center. 12 hours fast, driver, monitored BP for an hour before, etc etc.

    Today, they gave me an option for light sedation (i can't remember the name, it was something like Medazepam) The whole thing once the dr was in and ready took 5 minutes. I was in at 1030 and out at 12 including all the inbetween bs. I took the sedation for the purposes of easy pain relief thereafter, and i got about 4 hours out of it. Better than nothing! The only hitch in mine is i have pretty chronic high blood pressure and they harass me about it at every visit but my family dr isn't worried about it so I'm not either. Go back for another lesi in 16 days
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