SPMLs & EtOH

plastic arterial ‘needle’ (flexible arterial line over the needle). With success, that became a new item, plastic coated needle (so only the needle tip metal conduction is exposed to the surrounds). That needle is attached by wire to electronics with which we can find a nerve, identify which it is by its ‘stim’ response, pulse over drive it to see what other body parts far away react to it… and then

inject the 1cc with absolute certainty of safety and an expectation of efficacy. Everybody doing this stuff knew everybody else so choices and methods spread very fast as to how, but not so much as what to inject. Hamstring innervation has huge variation. It is so easy to think you ‘got’ the hamstring branch when in reality there were 3 branches that divided off higher up. Those pushing volume to get it all, saw the up-flow consequences as chemical sciatica burns from their choice of what to inject. Phenol = bad. Podiatrists got quite good at this. Our own wizard, Dr. Toufic Boucherie, a pain anesthesiologist [who mostly treat pain – post op or cancer related] could find the smallest nerve in a flea. He was really talented, but died young. A great deal of our precision and localization tricks were perfected by him using our electrical approach and x-ray. It became our job when he died. On whom was ethanol used mostly? There were patients that surgeons wouldn’t touch with ten foot poles. Athetoid and dystonic patients were notorious for going ‘bonkers’ after surgical MUSCLE procedures. Somehow, this was not so with the limited volume ethanol perineural injections. Without surgical options this group became physiatry property until we figured the work around. An aside: All sorts of things were being used to kill nerves – you saw the partial list – and so a simple name for all of it was ‘blocks’ – blocking nerve pathways to downstream muscles that were chosen to be culled from the herd.