Every thing you wanted to know about glycerine*

*But was afraid to ask

Every thing you wanted to know about glycerine*

*But was afraid to ask

Dr. G.V. LafargueDr. G.V. Lafargue

• 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

MODERN GLYCERIN Injections

Reterogasserian glycerol injection therapy in trigeminal neuralgiaReterogasserian glycerol injection therapy in trigeminal neuralgia Reterogasserian glycerol injection therapy in trigeminal neuralgiaReterogasserian 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

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

For spider veins, glycerin was more effective than polidocanol.

Samer Alaiti, MD,

Other doctors use 1% glycerin with lidocaine

For spider veins, glycerin was more effective than polidocanol.

Samer Alaiti, MD,

Other doctors use 1% glycerin with lidocaine

Sclerotherapy Treatment & Management

GLYCERIN CAUTIONSGLYCERIN CAUTIONSGLYCERIN CAUTIONSGLYCERIN CAUTIONS

Pain and dermal reaction caused by injected Pain and dermal reaction caused by injected glycerin in immunotherapy solutions glycerin in immunotherapy solutions

Pain and dermal reaction caused by injected Pain and dermal reaction caused by injected glycerin in immunotherapy solutions 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.

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% glycerolversus My maximum 1 ml of 50% glycerol

ProcalAmineProcalAmineProcalAmineProcalAmine

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)f Dean Reeves not me)

GLYCERIN MECHANISMS OF ACTIONGLYCERIN MECHANISMS OF ACTION

Glycerol neurolysis: neurophysiological effects of topical glycerol application on rat saphenous nerve

• 25% glycerol-blocks C-fiber not A-fiber conduction

• 50-100% glycerol-blocks C and A fiber conduction

• Burchiel KJ, and Russell LC.

Glycerin is a mild Glycerin is a mild peripheral neurolyticperipheral neurolytic

Glycerin is a mild Glycerin is a mild peripheral neurolyticperipheral neurolytic

Causes subperineurial damage.

Journal Neuron-May 2013Journal Neuron-May 2013Journal Neuron-May 2013Journal 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

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

Brachial Plexus Injection

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Brachial Plexus Injection

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N

LLLL

50 years before Dr. Halstead first brachial plexus block

Alexander Wood performed a brachial plexus block

Posterior brachial plexus techniquePosterior 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

Can perform with our without ultrasound

3cc of Isovue Dye3cc of Isovue Dye

Suprascapular nerveRegion

Axillary Plexus Region

RetrogradeDye Flow

OmohyoidOmohyoidThe 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

Cervical radiculopathy

F

-Spinal Cord Stimulator not working-Failed all meds including gabapentin

-Was in agony-begging for help

3 months after one injection-pain block3 months after one injection-pain block

CRPS-Hands-Sympathetic

blockade

CRPS-Hands-Sympathetic

blockade

Raynaud’s Phenomenon-Sympathetic

Blockade

Raynaud’s Phenomenon-Sympathetic

Blockade

Before and after and her photo

Before After

Glycerol Glycerol NeurolysisNeurolysisGlycerol Glycerol NeurolysisNeurolysis

MEDICARE GUIDELINESMEDICARE GUIDELINESMEDICARE GUIDELINESMEDICARE GUIDELINES

Must follow two successful facet/medial branch local anesthesia injections

Must follow two successful facet/medial branch local anesthesia injections

Nerve destruction by glycerol, alcohol, phenol, iced saline, heat or cold )

For medial branch nerves

Medial Branch NeurotomiesMedial Branch NeurotomiesMedial Branch NeurotomiesMedial Branch Neurotomies

SI joint chemical SI joint chemical neurotomiesneurotomies

SI joint chemical SI joint chemical neurotomiesneurotomies

Medicare Guidelines(check with your Medicare contractor)Medicare Guidelines

(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 GuidelinesMedicare 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