64449 Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)

Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)

Summary

This procedure involves injecting anesthetic agents or steroids into the lumbar plexus via a catheter placed through the posterior approach. This catheter allows for continuous infusion of the medication to manage pain.

Purpose

The primary goal of this procedure is to manage chronic pain or acute pain following surgeries involving the lower back, hips, or legs. The continuous infusion helps provide sustained pain relief.

Indications

• Chronic back pain
• Postoperative pain management for surgeries involving the lumbar region, hips, or knees
• Pain from conditions affecting the lower limbs, such as nerve injuries or spinal issues.

Preparation

• Patients may be advised to fast for a few hours prior.
• Medication adjustments may be necessary, particularly for blood thinners.
• Pre-procedure assessments might include a physical examination and medical history review.
• Imaging tests like X-rays or MRIs might be required to locate the exact site for catheter placement.

Procedure Description

1. Preparation: The patient lies on their side or stomach.
2. Anesthesia: Local anesthetic is applied to the skin where the catheter will be inserted.
3. Catheter Placement: Using a needle, the doctor locates the lumbar plexus and inserts a catheter via the posterior approach.
4. Infusion: Anesthetic agents or steroids are injected through the catheter, which remains in place for continuous medication delivery.

The tools include needles, catheters, syringe pumps, and possibly imaging technology for guidance. Sedation is generally minimal, using local anesthesia at the insertion site.

Duration

The procedure generally takes about 30 to 60 minutes.

Setting

The procedure is typically performed in a hospital, outpatient clinic, or a surgical center.

Personnel

• Anesthesiologist or pain management specialist
• Nurse or medical assistant
• Radiologist if imaging guidance is used

Risks and Complications

• Infection at the catheter site
• Bleeding or hematoma formation
• Nerve injury
• Allergic reactions to medication
• Catheter displacement or blockage

Benefits

• Effective pain relief that can be sustained over several days.
• Improved mobility and quality of life.
• Potential reduction in the need for oral pain medications.

Recovery

• Patients are usually monitored for a few hours post-procedure.
• Instructions include keeping the catheter site clean and dry.
• Limited physical activity is recommended initially.
• Follow-up appointments are necessary to monitor progress and remove the catheter.

Alternatives

• Oral pain medications
• Epidural steroid injections
• Physical therapy
• Surgery, in severe cases of nerve compression or damage

Each alternative has its pros and cons, such as differing levels of invasiveness, duration of relief, and side effects.

Patient Experience

During the procedure, patients may feel a mild pressure or discomfort at the insertion site. Post-procedure, local soreness is common. Pain levels typically decrease rapidly once the medication starts its effect. Comfort measures include prescribed analgesics and proper site care.