smoh/medical-transcriptions huggingface dataset:
Epidural Steroid Injection - 3  ( Pain Management)
Description:  Epidural steroid injection.  A total of 5 mL containing 4 mL of 0.25% bupivacaine and 80 mg of methylprednisolone acetate were infiltrated. 

PROCEDURE NOTE:,  The patient was placed in a prone position.  The neck was sterilely prepped using a cervical prep set.  A lidocaine skin wheal was raised over the C5-6 interspace.  A 20-gauge Tuohy needle was used.  Loss of resistance was obtained using hanging drop technique.  This was followed by 2 mL of radiograph contrast material which showed spread of the dye into the epidural space.  A total of 5 mL containing 4 mL of 0.25% bupivacaine and 80 mg of methylprednisolone acetate were then infiltrated.  Following the infiltration, the patient noted warming of his arms and dramatic improvement of his symptoms.  He was observed for 30 minutes and discharged home in good condition.  There were no apparent complications to the procedure.
Epidural Steroid Injection - 1  ( Pain Management)
Description:  L3-L5 epidural steroid injection with epidural catheter under fluoroscopy.

PREOPERATIVE DIAGNOSIS:,  Herniated lumbar disk with intractable back pain.,POSTOPERATIVE DIAGNOSIS: , Herniated lumbar disk with intractable back pain.,OPERATION PERFORMED: , L3-L5 epidural steroid injection with epidural catheter under fluoroscopy.,ANESTHESIA: , Local/IV sedation.,COMPLICATIONS: , None.,SUMMARY:  ,The patient in the operating room in the prone position with the back prepped and draped in the sterile fashion.  The patient was given sedation and monitored.  Local anesthetic was used to insufflate the skin over sacral hiatus.  A 16-gauge RK needle was placed at the sacral hiatus into the caudal canal with no CSF or blood.  A Racz tunnel catheter was then placed to the needle and guided up to the L3-L4 level.  After negative aspiration 4 cc of 0.5% Marcaine and 80 mg of Depo-Medrol were injected.  The catheter was then repositioned at the L4-L5 level where after negative aspiration same local anesthetic steroid mixture was injected.  Needle and catheter were removed intact.  The patient was discharged in stable condition.
Epidurogram  ( Pain Management)
Description:  Right L4, attempted L5, and S1 transforaminal epidurogram for neural mapping.

PREOPERATIVE DIAGNOSES:  ,1.  Right lower extremity radiculopathy with history of post laminectomy pain.,2.  Epidural fibrosis with nerve root entrapment.,POSTOPERATIVE DIAGNOSES:  ,1.  Right lower extremity radiculopathy with history of post laminectomy pain.,2.  Epidural fibrosis with nerve root entrapment.,OPERATION PERFORMED: , Right L4, attempted L5, and S1 transforaminal epidurogram for neural mapping.,ANESTHESIA:,  Local/IV sedation.,COMPLICATIONS: , None.,SUMMARY: , The patient in the operating room in the prone position with the back prepped and draped in the sterile fashion.  The patient was given sedation and monitored.  Local anesthetic was used to insufflate the skin and paraspinal tissues and the L5 disk level on the right was noted to be completely collapsed with no way whatsoever to get a needle to the neural foramen of the L5 root.  The left side was quite open; however, that was not the side of her problem.  At this point using a oblique fluoroscopic projection and gun-barrel technique, a 22-gauge 3.5 inch spinal needle was placed at the superior articular process of L5 on the right, stepped off laterally and redirected medially into the intervertebral foramen to the L4 nerve root.  A second needle was taken and placed at the S1 nerve foramen using AP and lateral fluoroscopic views to confirm location.  After negative aspiration, 2 cc of Omnipaque 240 dye was injected through each needle.,There was a defect flowing in the medial epidural space at both sides.  There were no complications.
Epidural Steroid Block  ( Pain Management)
Description:  Transforaminal epidural steroid block with fluoroscopy.

DIAGNOSIS: , Left sciatica.,ANESTHESIA: , Intravenous sedation,NAME OF OPERATION:,1.  Left L5-S1 transforaminal epidural steroid block with fluoroscopy.,2.  Left L4-5 transforaminal epidural steroid block with fluoroscopy.,3.  Monitored intravenous Versed sedation.,PROCEDURE: , The patient was taken to the block room.  He was placed prone on the fluoroscopy table.  He was monitored appropriately.  He was administered Versed 2 mg IV.  His O2 saturation remained greater than 90%.  His back was prepped and draped.  The C-arm was brought in.  The endplates at L5-S1 were squared off.  The C-arm was rotated to the left.  The L5 pedicle, the superior articular process of the L5-S1 facet, and the "neck of the scotty dog" were all visualized.  After adequate local anesthesia, a 22-gauge, 3-1/2-inch spinal needle was inserted using down-the-barrel-of-the-needle technique.  The needle was advanced into the posterior aspect of the foramen and then advanced anteriorly toward the 6 o'clock position on the pedicle.  No paresthesias were noted.  One-half cc of contrast was injected and spread medially around the pedicle and into the epidural space, and the L5 nerve root was visualized.  Depo-Medrol 80 mg plus 1 cc of 4% preservative-free lidocaine was injected.  The needle was flushed and removed.,I then went up to the L4-5 level, and using a similar technique, injected the patient transforaminally at the L4-5 level.  Depo-Medrol 80 mg plus 1 cc of 4% preservative-free lidocaine was injected at the L4-5 level just as at the L5-S1 level.  The patient had pain down his left leg during the injection, primarily at the L5-S1 level similar to what he normally experiences.  He was awake and alert, and taken to the recovery room in good condition.  His left leg pain was relieved.
Epidural Blood Patch  ( Pain Management)
Description:  Epidural Blood Patch.  An 18-gauge Tuohy needle was then placed in the epidural space on the first pass utilizing loss of resistance technique with a saline filled syringe. 

OPERATION:,
Epidural Steroid Injection  ( Pain Management)
Description:  Epidural steroid injection, epidurogram, fluroscopy - Low back pain, herniated disc, lumbosacral Facet, arthropathy.

PRE-OP DIAGNOSES:,  Low back pain - 724.2, Herniated disc - 722.10, Lumbosacral Facet, arthropathy - 724.4.,POST-OP DIAGNOSES: , Low back pain - 724.2, Herniated disc - 722.10, Lumbosacral Facet, arthropathy - 724.4.,INTERVAL HISTORY:,  Plans, risks and options were reviewed with the patient in detail.  The patient understands and agrees to proceed.,ANESTHESIA: , General Anesthesia,PROCEDURE PERFORMED:,  Epidural steroid injection, epidurogram, fluroscopy.,PROCEDURE:,  After informed consent, the patient was taken to the procedure room and placed in the prone position.  EKG, blood pressure and pulse oximetry were monitored and remained stable throughout the procedure.  The area was prepped and draped in the usual sterile fashion.  Local anesthetic was infiltrated at the appropriate level.  Fluoroscopic guidance was used to place a #20-gauge Tuohy epidural needle gently into the epidural space at L4-L5 using a paramedian approach.  No blood or CSF was obtained on aspiration.,RADIOLOGY: , Injection of 3 cc of OMNIPAQUE showed spread of the dye into the epidural space on AP and Lateral imaging.  The Needle was injected with Depo-Medrol 80 mg with Bupivacaine 1/16th , 8 cc total vol.  Patient tolerated procedure well and was transferred to recovery room.  Patient was discharged home with escort.  Discharge instructions were given.,POST-OP PLAN:,  I will see the patient back in my office in two weeks.  Continue p.r.n. medications as needed.
Cervical Selective Nerve Root Block  ( Pain Management)
Description:  Cervical Selective Nerve Root Block

CERVICAL SELECTIVE NERVE ROOT BLOCK,PREPROCEDURE PREPARATION:,  After being explained the risks and benefits of the procedure, the patient signed the standard informed consent form.  The patient was placed in the prone position and standard ASA monitors applied.  Intravenous access was established and IV sedation was used.  For further details of IV sedation and infusion, please refer to anesthesia notes.  The patient was able to respond appropriately throughout the procedure.  * Fluoroscopy was used to identify the appropriate anatomy.  The skin was prepped and draped in a sterile fashion and sterile technique was maintained throughout the procedure.,PROCEDURE DETAILS:,  The patient was laid supine.  Oblique placement was achieved by placing pillow below the shoulder and turning the head.  The C# neural foramina was identified by counting down from the C2-3 foramen.  The external carotid artery was marked off by palpation.  The neck was aseptically prepared.  1% lidocaine was used for local infiltration and subsequently a 25-gauge spinal needle was passed down to the C# neural foramen under fluoroscopic control.  The posterior inferior edge of the foramen bone was contacted.  The needle was then redirected and slowly walked off the bone into the foramen by a few millimeters.  Care was taken to remain in the posterior inferior edge of the foramen.  Positioning was checked by AP view, in which the needle tip extended no further medially than the midpoint of the adjacent pedicle.  1 mL of contrast was used to confirm position under fluoroscopy after aspiration.  Acceptable dye pattern was seen.  Subsequent 1 mL of 1% lidocaine was injected after aspiration and the patient was monitored.  No adverse affects with 1% lidocaine were noted and subsequently 1 mL of Celestone was injected.  Compression bandage was applied to the neck and no complications were noted.,POSTPROCEDURE EVALUATION:,  After a 30-minute recovery period, during which no complications were noted, the patient was discharged home.  Pulse oximetry was carried out on room air in recovery and all oxygen saturations were above 95% with no respiratory distress observed.
Coccygeal injection  ( Pain Management)
Description:  Coccygeal injection

COCCYGEAL INJECTION,PROCEDURE:,:  Informed consent was obtained from the patient.  A gloved little finger was inserted into the anal region and the sacral/coccygeal joint was palpated and the coccyx was moved and it was confirmed that this reproduced pain.  After aseptic cleaning, a 25-gauge needle was inserted through the skin into the sacral/coccygeal joint.  It was confirmed that the needle was not entering the rectal cavity by finger placed in the rectum.  After aspiration, 1 mL of cortisone and 2 mL of 0.25% Marcaine were injected at the site.  Postprocedure, the needle was withdrawn.  A small pressure dressing was placed and no hematoma was observed to form.,POST PROCEDURE INSTRUCTIONS:, The patient has been asked to report to us any redness, swelling, inflammation, or fevers.  The patient has been asked to restrict the use of the * extremity for the next 24 hours.
Cervical Medial Branch Blocks  ( Pain Management)
Description:  Cervical spondylosis.  Cervical medial branch blocks under fluoroscopic control.

PREOPERATIVE DIAGNOSIS:,  Cervical spondylosis.,POSTOPERATIVE DIAGNOSIS:,  Cervical spondylosis.,OPERATION PERFORMED:,  Cervical Medial Branch Blocks under fluoroscopic control.,ANESTHESIA:,  Local and IV.,COMPLICATIONS:,  None.,DESCRIPTION OF PROCEDURE:,  After proper consent was obtained, the patient was taken to the fluoroscopy suite and place on a fluoroscopy table in a prone position with a chest roll in place.  The neck was placed in a flexed position.  The patient was monitored with blood pressure cuff, EKG, and pulse oximetry and given oxygen via nasal cannula.  The patient was lightly sedated.  The skin was prepped and draped in a sterile classical fashion.,Under fluoroscopy control, the waists of the articular pillars were identified and marked.  Local anesthesia infiltrated subcutaneously and deep extending down toward these previously marked points.  Once the anesthesia was established, a 10-cm, 22-gauge needle was placed in contact with the waists of the articular pillars at the affected levels that were previously mentioned.  This was done under direct fluoroscopic control with PA views initially for orientation utilizing a gun barrel technique and then a lateral view to determine the depth of the needle.  The needle tip was positioned such that the tip was at the posterior aspect of the articular pillar's waist and was then incrementally advanced until the tip was at the center of the pedicle, where the medial branch lies.  For C3 to C6, the medial branch is along the ventral aspect of a line that connects the greatest antero-posterior diameter of the articular pillar but remains dorsal to the foramen as seen on lateral imaging.  For a C7 medial branch block, the needle tip is positioned more superiorly such that it overlies the superior articular process.  For a C8 medial branch block, the needle is placed at the junction of the superior articulating facet and the base of the transverse process of T1.,Once the needles were in place, each level was then injected with 1cc of a 10 cc solution of Marcaine 0.5% mixed with 50mg on methyl prednisolone acetate.  The patient tolerated the procedure well without any difficulties or complications.
Costochondral Cartilage Injection  ( Pain Management)
Description:  Costochondral Cartilage Injection

COSTOCHONDRAL CARTILAGE INJECTION,PROCEDURE PREPARATION:,  After being explained the risks and benefits of the procedure, the patient signed the standard informed consent form.  The patient was placed in the supine position.,Intravenous access was established.  The patient was given mild narcotics for sedation.  For further details, please refer to anesthesia note.,DESCRIPTION OF PROCEDURE:,  The area of discomfort was palpated under fluoroscopy and the costochondral cartilages that were symptomatic were marked out.  After careful asepsis, local anesthesia was given subcutaneously and a 0.25-gauge hypodermic needle was inserted into the costochondral cartilage junction, taking care not to stray from the rib.  Fluoroscopy in AP and lateral positions confirmed good position of the needle in the * costochondral junction and subsequently after aspiration, 0.5 mL of Depo-Medrol 80 and 0.5 mL of 0.5% Marcaine was injected.  The same procedure was carried out at the * costochondral junction.,POSTPROCEDURE INSTRUCTIONS:,1.  After a period of 30 minutes of observation, during which there was no distress and good relief of symptoms was noted, the patient was discharged home.,2.  The patient has been given instructions on watching for possible pneumothorax and any respiratory distress.  The patient will call us if any inflammation, swelling, or other associated discomfort arises.  We will call the patient in 48 hours.
Caudal Epidural Steroid Injection  ( Pain Management)
Description:  Caudal epidural steroid injection

CAUDAL EPIDURAL STEROID INJECTION,PROCEDURE:,:,1.  Caudal epidural steroid injection with contrast.,2.  Utilization of fluoroscopy for confirmation of needle placement.,PREPROCEDURE PREPARATION:,  After being explained the risks and benefits of the procedure, the patient signed the standard informed consent form.  The patient was placed in the prone position and standard ASA monitors applied.  Intravenous access was established and IV sedation was used.  For further details of IV sedation and infusion, please refer to anesthesia notes.  Fluoroscopy was used to identify the appropriate anatomy.  The skin was prepped and draped in a sterile fashion and sterile technique was maintained throughout the procedure.,PROCEDURE DETAILS:,
Cervical Epidural Steroid Injection  ( Pain Management)
Description:  Cervical epidural steroid injection without fluoroscopy.  An 18-gauge Tuohy needle was placed into the epidural space using loss of resistance technique.

PROCEDURE:,  Cervical epidural steroid injection without fluoroscopy.,ANESTHESIA: , Local sedation.,VITAL SIGNS: , See nurse's notes.,COMPLICATIONS: , None.,DETAILS OF PROCEDURE: , INT was placed.  The patient was in the sitting position.  The posterior neck and upper back were prepped with Betadine.  Lidocaine 1.5% was used for skin wheal made between C7-T1 ________.  An 18-gauge Tuohy needle was placed into the epidural space using loss of resistance technique and no cerebrospinal fluid or blood was noted.  After negative aspiration, a mixture of 5 cc preservative-free normal saline plus 160 mg Depo-Medrol was injected.  Neosporin and band-aid were applied over the site. The patient discharged to recovery room in stable condition.
Depo-Medrol Injection  ( Pain Management)
Description:  Right L5-S1 intralaminar epidural steroid injection with 120 mg of Depo-Medrol under fluoroscopic guidance.  The patient is a 51-year-old female with back pain referring into the right leg.

PROCEDURE: , Right L5-S1 intralaminar epidural steroid injection with 120 mg of Depo-Medrol under fluoroscopic guidance.,INDICATION: , The patient is a 51-year-old female with back pain referring into the right leg.,RISKS VERSUS BENEFITS: , The risks and benefits were discussed with the patient prior to the procedure.  She agrees to accept the risks and signs a written consent to proceed with the procedure.,DESCRIPTION OF PROCEDURE: , The patient was placed prone on the table.  The skin was thoroughly cleansed with Betadine swabs x3 and wiped off with a sterile gauze.  The subcutaneous intramuscular and interligamentous region was anesthetized with 4% lidocaine.,A 3-1/2-inch 20-gauge Tuohy catheter was directed under intermittent fluoroscopic guidance at the lamina.  Once the lamina was detected, the catheter was directed cephalad and medially and loss of resistance technique was used to determine the epidural space.,EPIDUROGRAM: , Omnipaque 300 1.5 mL was placed just to the right of the midline.  This was viewed on the AP and lateral projections.  It showed typical epidural spread pattern with good cephalad and caudad flow, and the flow was unrestricted.,Depo-Medrol 120 mg along with an additional bacteriostatic normal saline for a total of 60 mL injected solution was placed just to the right of the midline at L5-S1.,The patient tolerated the procedure well without procedural complications.  She will follow up with me in the office in the next few weeks to monitor her response to the injection.
Celiac Plexus Block  ( Pain Management)
Description:  Standard celiac plexus block procedure note.

NAME OF PROCEDURE: , Celiac plexus block.,ANESTHESIA:,  Local/IV sedation.,COMPLICATIONS:,  None.,PROCEDURE: , INT was placed.  The patient was in the prone position back prepped and draped in sterile fashion.  Then 1.5% of Lidocaine for skin wheal was made approximately 10 cm lateral to the L1-L2 vertebral junction.  A 20 gauge, 15 cm needle was then placed in a cephalad medial 45o direction; the tip of the needle was just inside the L1 vertebral body.  On lateral view, this was noted to be approximately 1.5-2.5 cm anterior to the vertebral body.  At this time, 3 cc of Omnipaque dye was injected to the opposite side where the same sequence was performed.  Following this, a mixture of 18 cc of 0.5% Marcaine was injected on each side Neosporin and band-aids was applied over the puncture sites.  The patient was taken to the outpatient recovery where blood pressure was monitored and fluids given as needed.  The patient was discharged to operating room recovery in stable condition.
Cervical Epidural Steroid Injection - 2  ( Pain Management)
Description:  Cervical epidural steroid injection, C5-6.  The C-arm was brought into the operative field and an AP view of the lumbar spine was obtained with particular attention to the C5-6 level. 

PROCEDURE PERFORMED:,  Cervical epidural steroid injection, C5-6.,ASSISTANT:,  None.,ANESTHESIA:,  Local.,DETAILS OF PROCEDURE: , The patient was brought to the operating theater and placed prone onto the radiolucent table.  Subsequent monitored anesthesia care was administered.  The C-arm was brought into the operative field and an AP view of the lumbar spine was obtained with particular attention to the C5-6 level.  The neck area was then prepped with Betadine solution and draped sterile.  A metallic marker was placed over the C5-6 lamina and a skin wheal was raised in the skin.  A #20-gauge Tuohy needle was then advanced into the spinal canal using 1% Xylocaine anesthetic and the depth of penetration to the C5 lamina was determined.  The needle was redirected into the interlaminar space and advanced to the previously determined level.  A 10 cc syringe was then placed onto the end of the needle and, using an air-negative technique, the needle was advanced into the epidural space.  When a free flow of air was produced, a solution of 80 mg Depo-Medrol, 2 cc of 1% Xylocaine injectable, and 5 cc of normal saline was then injected into the epidural space.  The Tuohy needle was removed.  Betadine was cleansed from the skin.  A bandage was placed over the needle entrance point.  The patient was turned supine onto a regular hospital bed and subsequently allowed to be awakened from anesthesia.  The patient was taken to the recovery room in stable condition.
Cervical Facet Joint Injection  ( Pain Management)
Description:  Cervical facet joint injection with contrast

CERVICAL FACET JOINT INJECTION WITH CONTRAST.,PREPROCEDURE PREPARATION:,  After being explained the risks and benefits of the procedure, the patient signed the standard informed consent form. the patient was placed in the prone position and standard ASA monitors applied.  Intravenous access was established and IV sedation was used.  For further details of IV sedation and infusion, please refer to anesthesia notes.  Fluoroscopy was used to identify the appropriate anatomy and symptomatic facet joints.  The skin was prepped and draped in a sterile fashion and sterile technique was maintained throughout the procedure.,PROCEDURE DETAILS:,  The patient was laid supine.  Appropriate view of facet joints was achieved by placing pillow below the shoulder and turning the head.  The neck was aseptically prepared.  1% lidocaine was used for local infiltration and subsequently a 25-gauge spinal needle was passed down to the C4-5 facet joint under fluoroscopic control.  Positioning was checked and 0.2 mL of dye was injected.  Acceptable dye pattern was seen.  Subsequent 1 mL of a mixture of 0.5 mL of 1% lidocaine and 0.5 mL of Celestone was injected after aspiration and the patient was monitored.  Needle was removed and same procedure carried out on the other side.  Postprocedure, no complications were noted.
Cervical Epidural Steroid Injection - 1  ( Pain Management)
Description:  Cervical epidural steroid injection C7-T1.  An 18-gauge Tuohy needle was then placed in the epidural space with loss of resistance technique and a saline-filled syringe utilizing a midline intralaminar approach.

OPERATION PERFORMED: , Cervical epidural steroid injection C7-T1.,ANESTHESIA:,  Local and Versed 2 mg IV.,COMPLICATIONS:  ,None.,DESCRIPTION OF PROCEDURE:  ,The patient was placed in the seated position with the neck flexed the forehead was placed on a cervical rest.  The head and cervical spine were restrained.  The patient was monitored with a blood pressure cuff, EKG and pulse oximetry.  The skin was prepped and draped in sterile classical fashion.  Excess cleansing solution was removed from the skin.  Local anesthesia was injected at C7-T1.  An 18-gauge Tuohy needle was then placed in the epidural space with loss of resistance technique and a saline-filled syringe utilizing a midline intralaminar approach.,Once the epidural space was identified, a negative aspiration for heme or CSF was done.  This was followed by the injection of 6 cc of saline mixed with methyl prednisolone acetate 120 mg in aliquots of 2 cc.  Negative aspirations were done prior to each injection.  The needle was cleared with saline prior to its withdrawal.  The patient tolerated the procedure well without any apparent difficulties or complications.