Transcript Every thing you wanted to know about glycerine* *But was afraid to

Every thing you wanted
to know about
glycerine*
*But was afraid to ask
Dr. G.V. Lafargue
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October 4, 1836, he began the era of subcutaneous
peripheral nerve injections.
Cured his own arm neuralgia with 13 lancet injections.
Used aqueous morphine powder.
Letter-Dr. LaFargue-inoculation of morphine with the lancet. Bull. Acad.
Med. Paris
MODERN GLYCERIN
Injections
Reterogasserian glycerol injection therapy in trigeminal neuralgia
552 patients treated with a single injection.
59.1% pain-free-2 years
Complications were few and not incapacitating.
Conclusion: The technique-safe, cheap and effective in treating trigeminal
neuralgia.
S Saini
et al
Sclerotherapy Treatment & Management
For spider veins, glycerin was more effective than polidocanol.
Samer Alaiti, MD,
Other doctors use 1% glycerin with lidocaine
GLYCERIN CAUTIONS
Pain and dermal reaction caused by injected
glycerin in immunotherapy solutions
Injected glycerin produces pain that is proportional to total injected dose of
glycerin,
Van Metre TE Jr, Rosenberg GL, Vaswani SK, Ziegler SR, Adkinson NF.
NOTE: Can greatly reduce glycerin induced pain with small doses of
lidocaine.
Glycerol-induced hemoglobinuric acute renal failure in the rat.
1. Micropuncture study of the development of oliguria.
Rats-50%glycerol-10ml per kg of body weight
DONALD E.OKEN et. al.
To compare their amounts to used in rats to humans:
Humans-70 kg=700 ml of 50% glycerol
versus My maximum 1 ml of 50% glycerol
ProcalAmine
Given as IV hyperalimentation
infiltrates all the time up to 50 mls
contains 3% Glycerin Injection
No reported renal complications
(this is the work of Dean Reeves not me)
GLYCERIN MECHANISMS OF ACTION
Glycerol neurolysis: neurophysiological effects of
topical glycerol application on rat saphenous nerve
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25% glycerol-blocks C-fiber not A-fiber conduction
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50-100% glycerol-blocks C and A fiber conduction
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Burchiel KJ, and Russell LC.
Glycerin is a mild peripheral
neurolytic
 Causes subperineurial damage.
Journal Neuron-May 2013
Crippled mitrochondria in Schwann cells
Instead of synthesizing fatty acids broke them down
Build up of a acylcarnitine-a toxin
Interferes with neuron transmission
Result was peripheral neuropathy
Supports Liza’s pre-NPT theory that dextrose works as a food
BRACHIAL
PLEXUS
INJECTIONS
50 years before Dr. Halstead first brachial plexus
block
Alexander Wood performed a brachial plexus
block
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Posterior brachial plexus
technique
Locate the SGN notch on the spine of the scapula
Can inject 1 inch deep or to bone
Inject 3-10 cc of of glycerin 3% solution
3cc of Isovue Dye
Suprascapular nerve
Region
Axillary Plexus
Region
Retrograde
Dye Flow
Omohyoid
The Omohyoid arises from the upper border of the scapula,
Attachment to the scapula varying from a few millimeters to
2.5 cm.
GLYCERIN CASE HISTORIES
Young lady with back pain severe enough to
place her in an extended care facility
Dextrose to cluneal nerves only lasted a few
days
One session glycerin 3% to cluneal nerves
produced almost complete pain relief for 3
months.
Cervical
radiculopathy
-Spinal Cord Stimulator not working
-Failed all meds including gabapentin
-Was in agony-begging for help
3 months after one
injection-pain block
CRPS-HandsSympathetic blockade
Raynaud’s
PhenomenonSympathetic Blockade
Before
After
Glycerol Neurolysis
MEDICARE GUIDELINES
Nerve destruction by glycerol, alcohol, phenol, iced
For medial branch
nerves
Must follow two successful facet/medial
branch local anesthesia injections
Medial Branch Neurotomies
SI joint chemical neurotomies
(check with your Medicare contractor)
Peripheral nerve blocks involve the injection
of chemical substances, such as local
anesthetics, steroids, sclerosing agents
and/or neurolytic agents into or near nerves
to affect therapy for a pathological
condition, such as entrapment.
Any billing of insurance or Medicare is the sole
responsibility of the attendee not the lecturer
Medicare Guidelines
No more than 3 injections per site in a 6 month period.
No more than 2 different sites at any one session.
NOVATIS SOLUTIONS, INC CMS CONTRACT CENTER
FOR MEDICARE AND MEDICAID SERVICES
Peripheral nerve injections
Pre-approval with:
California’s Worker’s Compensation