64446 Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement)

Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement)
Common Name(s): Continuous Sciatic Nerve Block, Sciatic Nerve Catheter Infusion

Summary

In this procedure, a catheter is placed near the sciatic nerve to deliver a continuous infusion of anesthetic or steroid medication. This helps manage pain, particularly after surgeries involving the lower limb. The continuous infusion through the catheter ensures prolonged pain relief.

Purpose

The primary aim is to provide extended pain relief, especially post-surgery, for conditions affecting the lower limb. Continuous infusion can also help in reducing inflammation and improving mobility during the recovery process.

Indications

• Severe postoperative pain in the lower extremities.
• Chronic pain conditions involving the sciatic nerve.
• Lower limb surgeries such as knee arthroplasty, foot and ankle surgeries.
• Patients requiring extended pain management.

Preparation

• The patient may need to fast for several hours before the procedure.
• Medication adjustments might be necessary; patients should follow instructions from their healthcare provider.
• Pre-procedure assessments like blood tests or imaging studies (e.g., MRI, ultrasound) may be required to plan the catheter placement.

Procedure Description

1. The patient is positioned to allow access to the sciatic nerve.
2. The injection site is cleaned and sterilized.
3. Local anesthesia may be applied to numb the insertion area.
4. Using ultrasound or nerve stimulation guidance, a needle is inserted near the sciatic nerve.
5. A catheter is threaded through the needle and positioned close to the nerve.
6. The needle is removed, leaving the catheter in place.
7. Continuous infusion of anesthetic or steroid medication is started using an infusion pump.
8. The catheter is secured and covered with a sterile dressing.

Duration

The procedure typically takes about 30 to 60 minutes to complete.

Setting

The procedure is usually performed in a hospital setting, either in an operating room or a specialized pain management clinic.

Personnel

• Anesthesiologist or pain management specialist
• Assisting nurse
• Ultrasound technician (if imaging guidance is used)

Risks and Complications

• Infection at the catheter insertion site
• Bleeding or hematoma formation
• Nerve damage or irritation
• Catheter dislodgement or blockage
• Allergic reactions to the medication
• Prolonged numbness or weakness in the leg

Benefits

• Effective pain relief for an extended period.
• Reduced need for systemic pain medications.
• Improved postoperative mobility and recovery.
• Targeted treatment of sciatic nerve-related pain conditions.

Recovery

• Follow post-procedure care instructions provided by the healthcare team.
• Keep the catheter site clean and dry.
• Report any signs of infection or complications immediately.
• Patients can usually resume gentle activities as advised but should avoid strenuous activities until fully recovered.
• Follow-up appointments will be scheduled to monitor progress and remove the catheter as necessary.

Alternatives

• Oral or intravenous pain medications.
• Single-injection nerve blocks.
• Physical therapy or alternative pain management techniques.
• Each alternative has its pros and cons, such as varying durations of pain relief and potential side effects.

Patient Experience

During the procedure, the patient might feel mild discomfort or pressure at the insertion site. Post-procedure, the area may be numb initially, and pain relief should begin shortly after the infusion starts. Pain management and comfort measures, including medication adjustments and supportive care, will be provided to ensure the patient's comfort throughout the recovery process.