Private Practice Pain Doc

I use the vendor Henry Schein to purchase the majority of the supplies I need to run a private practice, and have had a generally positive experience with them. However, over the past couple of years, certain items that are critical to performing pain management procedures have been difficult to obtain due to “supply chain issues”, including the procedure kits that come with skin cleaning solution, gauze, syringes, needles, local anesthetic, saline, etc. – all the items you need to conveniently and efficiently perform virtually any pain management procedure. Moreover, the prices for the kits that are available have gone up substantially.

To save money and to ensure that I have all the materials I need to perform the most common procedures in pain management (i.e. epidurals, joint injections, nerve blocks), I started to keep track of the minimum materials required and began ordering them individually. I found that the cost of creating my own pain management procedure kit is extremely low, and helps simplify the process of performing certain procedures.

Here are all of the items included in my DIY pain management procedure kit:

• Criterion CR Polychloroprene Surgical Gloves, size 7.5 ($1.28 per glove)
• Surgical Prep Swabstick PVP Iodine 10% ($0.46 per pack)
• Triamcinolone Acetonide Injection 40mg/mL, 1mL ($7.87 per vial)
• Lidocaine HCl Injection 2% Preservative Free, 5mL ($1.61 per vial)
• Omnipaque Injection 240mg/mL PlusPak Bottle, 50mL ($6.74 per vial)
• Luer Lock Syringe 10cc Clear Low Dead Space ($0.09 per syringe)
• Luer Lock Syringe 5cc Clear Low Dead Space ($0.07 per syringe)
• Luer Lock Syringe 3cc Clear Low Dead Space ($0.05 per syringe)
• IV Extension Set Needleless 6″ Female Luer Lock Adapter ($1.06 per IV extension set)
• Needle 22gx3-1/2″ Quincke Spinal Black ($3.73 per needle)

Excluding the steroid and contrast, my DIY procedure kit costs about $8.35. The simplest kit that I found on Henry Schein costs about the same amount, but doesn’t include the procedure needle. I learned to use the wrapper for the sterile gloves as my sterile field as a resident doing peripheral nerve blocks during my regional anesthesia rotations. Just open the wrapper without touching the inside, and drop all your materials onto it, like in the picture!

In an effort to save even more money, I started following the advice of some of my friends and colleagues who work in academic pain clinics at places such as UCLA and Northwestern University who told me that they temporarily stopped using contrast dye for certain procedures such as lumbar epidural steroid injections and joint injections because there has been a critical shortage of contrast dye. Supply chain constraints have preferentially funneled this drug primarily to cardiology and interventional radiology suites, where contrast dye is also used for more urgent and emergent procedures. The only procedures I would never skip using contrast dye for are cervical epidural steroid injections, and sympathetic nerve blocks.