62281 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic

Name of the Procedure:

Injection/Infusion of Neurolytic Substance for Pain Management Technical/Medical Term: Neurolytic Block, Epidural Injection (Cervical or Thoracic)

Summary

This procedure involves injecting or infusing a neurolytic substance such as alcohol, phenol, or iced saline solutions into the epidural space of the cervical or thoracic spine. It may include other therapeutic substances. The aim is to relieve chronic pain by interrupting nerve signal transmission.

Purpose

This procedure addresses chronic pain conditions that haven't responded to conservative treatments. The goal is to provide long-term pain relief by disrupting the pain signals transmitted through the affected nerves.

Indications

• Chronic pain in the cervical or thoracic region
• Nerve pain (neuropathy)
• Cancer-related pain
• Failed back surgery syndrome
• Persistent pain after injuries

Patient criteria:

• Patients with severe, chronic pain that has not been managed by medications or physical therapy
• Individuals in good general health who can tolerate the procedure

Preparation

• Fasting for 6-8 hours prior to the procedure
• Medication adjustments (e.g., blood thinners may need to be paused)
• Diagnostic imaging (MRI or CT scan) to identify the precise area for injection

Procedure Description

1. The patient lies on an exam table.
2. The skin over the injection site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. A needle is guided into the epidural space using fluoroscopy (X-ray guidance).
5. Once correctly positioned, the neurolytic substance is injected or infused.
6. The needle is removed, and a bandage is applied to the injection site.

Tools and Equipment:

• Sterile needles and syringes
• Fluoroscopy (X-ray) machine
• Local anesthetic
• Neurolytic agents (e.g., alcohol, phenol)

Duration

The procedure typically takes 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital or outpatient surgical center equipped for fluoroscopic guidance.

Personnel

• Pain specialist or anesthesiologist
• Nurse or medical assistant
• Radiologic technologist (for fluoroscopy)

Risks and Complications

Common Risks:

• Bleeding at the injection site
• Infection
• Temporary increase in pain Rare Risks:
• Nerve damage
• Paralysis
• Allergic reaction to the injected substances

Benefits

• Long-term relief from chronic pain
• Improved quality of life
• Reduction in the need for pain medications

Recovery

• Patients are usually monitored for a few hours post-procedure.
• Mild soreness at the injection site may occur.
• Instructions typically include rest for 24 hours and avoiding strenuous activity.
• A follow-up appointment is usually scheduled to assess effectiveness.

Alternatives

• Oral or topical pain medications
• Physical therapy
• Surgical interventions
• Radiofrequency ablation
• Spinal cord stimulation

Pros and Cons of Alternatives:

• Oral medications may have systemic side effects and less targeted pain relief.
• Surgery carries higher risks but may provide a more permanent solution.

Patient Experience

During the procedure, patients might feel pressure or mild discomfort. After the procedure, there could be temporary soreness at the injection site. Pain management measures, including prescribed medications, are provided to ensure comfort and address any post-procedure pain.