All cases assigned to us today are ESI (Epidural Steroid Injections). This is not alien term to me as I’ve spoken to so many patients in Loma Linda about Steroid Injections, why they chose ESI and why they are coming back to do it again. I’ve seen as many as 20 (?) scheduled in one day for Epidural Shots, so 4 is not that much in comparison. Of course, the Clinical side is so much different from that of the non-clinical aspect of a patient’s visit, so to be given that opportunity to see it happening, and be a part of their patient care pre and post-op is, for me, an experience of a lifetime.

Going back to today’s procedures. I want to be able to write down each and every activity including supplies and equipments we used. So, here they are:

Lidocaine/Local – 10 ml/vial, preservative free
Celestone – 5 ml/vial
Marcaine (Bupivicane) – 5 ml/vial, preservative free
Omnipaque (Dye) – 50 ml/bottle
Naropin – if doing bursa/hip

Anesthesia Machine – MAC
C-Arm for x-ray
Ultrasound Machine if doing versa, needs sterile drape and sterile gel

After ordering x-ray from Radiology, I interviewed the patient making sure that all pre-op questions are answered, consent is signed on time, H&P is current and all meds are reconciled. Upon taking patient to OR, assisted patient on prone position on the OR table. While Dr is getting ready for procedure, I read medications (local, marcaine and dye) to surgical tech and pour on cups to the backtable.

What makes the procedure longer is the process of locating the space to inject the steroid. That requires x-ray and careful positioning of needle. This can sometimes take 20 minutes or more. However, as soon as location is satisfactory based on what the Dr sees on x-ray monitor (with the help of the dye), a mixture of 1 1/2 ml marcaine and 1/2 ml Celestone is administered in as fast as a minute.

For injections on bersa, ultrasound machine must be used to locate the bersa muscle. The ultrasound machine will be draped with sterile drape and a sterile gel is used.The Dr usually have their own concoction of meds and all we had to do is pour on a cup at the backtable after reading every bottle to Surgical Tech.

After four cases, I feel competent enough for the next ESI cases. I am thankful for having a great mentor in Kate, and for all the wonderful Doctors and OR staff I am currently working with.


Attached Image: NJSR at