More than 2600 clinicians registered for Dr. David Rosenblum’s recent webinar with Clarius, which is now available to watch on demand — Precision in Pain Management: Ultrasound-Guided Therapies for Chronic Head and Neck Pain.  The Director of Pain Medicine at Maimonides Medical Center in New York, Dr. Rosenblum is a leading expert in pain management and a strong advocate for using ultrasound guidance in pain procedures.    

Watch the webinar to see Dr. Rosenblum demonstrate how he uses Clarius ultrasound to improve the accuracy and effectiveness of cervical spine injections for pain management. Although these procedures have historically been performed under fluoroscopy, he shows how he expertly targets precise delivery of medication using ultrasound as a guide for safe and accurate cervical spine injections. 

Scroll down for some quick clinical takeaways, Q&A highlights, and short classroom videos of Dr. Rosenblum’s expert techniques. 

Dr. David Rosenblum, Director of Pain Medicine at Maimonides Medical Center in New York, presented a webinar on ultrasound-guided nerve blocks for chronic head and neck pain.  

Key Clinical Takeaways 

• Cervical Plexus Blocks: Superficial cervical plexus blocks are ideal for beginners due to their superficial location, while deep cervical plexus blocks are more advanced.

• Selective Nerve Root Blocks: These blocks can effectively address cervical radiculopathy, even though they are not currently reimbursed in the United States.

• Ultrasound Guidance: Ultrasound guidance allows for real-time visualization of nerves and other structures, enabling precise needle placement and reducing the risk of complications.

• Safety: Always use Doppler to identify blood vessels and avoid vascular injury. Visualize the needle tip at all times to prevent accidental needle placement.    

• Advanced Procedures: Selective nerve root blocks and other deep injections require advanced skills and should only be performed by experienced practitioners.    

Q&A Highlights from the Webinar 

Do you do subscapularis nerve block for complicated shoulder capsulitis that don’t respond to classic treatment?  

I do mainly suprascapular nerve blocks, not so much subscapularis. That’s enough for the frozen shoulder.”

Watch this 2-minute video of Dr. Rosenblum demonstrating a suprascapular nerve block

What do you use for your pain injections? 

Sometimes I use dexamethasone mixed with either lidocaine or bupivacaine. The injections, they vary tremendously. Many times, you don’t need steroids to get relief. And if it’s a chronic issue, I would definitely recommend trying platelet-rich plasma.”

How long does pain relief last for your patients? 

Anywhere from a few hours to a few years. It really varies with people with just lidocaine. I’d say out of all the local anesthetics, lidocaine, despite its short duration compared to bupivacaine, has a better chance at giving long-term relief than bupivacaine. That’s just anecdotal. So, no reference, no study.”

What is your aseptic technique for using the ultrasound and probe without a probe cover? 

The Clarius probes are waterproof. So, you could use a core prep or Clorox solution to clean them and they’re sterile after that. I’m never putting gel over my needle entry point. That’s something that comes with time. When you’re first starting injections, use the condom and every sterile thing you could use. It should be really the same risk as doing a blood draw or giving a flu vaccine or any other shot; just prep it with chlorhexidine.”

What approach is preferred for stellate blocks, medial or lateral?  

I think it varies on the practitioner, and it varies from patient to patient. Sometimes I’ll do lateral, but nine out of 10 times I do medial, I find it’s a shorter distance. And if the thyroid is clean, you don’t see the blood vessels there, you just go straight through it. But you have to have very good coordination to see your needle the whole time because you could very easily wind up in the carotid, which could be a disaster. ”

Is there a maximum number of injections a person can have for chronic neck pain?  

So, in the United States, you’ll typically get paid for one thing at a time. In other countries you could do multiple treatments. If you’re treating a patient with a neck, shoulders, arms, headaches, that whole thing related to cervical disc herniation, cervicalgia, radiculopathy. And one epidural could basically terminate all that. Epidurals do work great. I’m not against them. I just think there are less invasive means. And sometimes when you don’t do the epidural and you go to the brachial plexus or the exiting nerve root or the paravertebral, you’ll need to supplement by doing all those little peripheral injections, which means more needle sticks. But these are low risk needles. And if you see in the image in the videos, I’m using very low volumes. So, you’re getting a lot of relief at the different peripheral targets, but you’re nowhere near the spinal cord. So, it really depends on how comfortable you are and your individual patient. I just try to do what the patient needs. Nothing more, nothing less.”

Watch this detailed 8-minute video of Dr. Rosenblum demonstrating a series of cervical injections to treat his patient’s neck and arm pain and headaches. 

Visualize Your Needle in High Definition for Safe and Precise Pain Medicine Procedures 

Dr. Rosenblum uses Clarius wireless handheld ultrasound equipped with AI-powered Voice Control at his clinic. To learn about Dr. Rosenblum’s experience with Clarius ultrasound, read this article, which features a 5-minute video. 

Recognized for the best imaging quality among handheld systems, Clarius HD3 is highly affordable, easy to learn and use. With clear nerve and musculoskeletal imaging, watch your needle hit the target. Visit our Pain Management specialty page to learn more. A Clarius expert is available to provide a custom virtual demonstration. Contact us to schedule a demo at a time that works for you.