Name of the Procedure:

Injection/Infusion of Neurolytic Substance (e.g., alcohol, phenol, iced saline solutions); Epidural, Lumbar, Sacral (Caudal)

Summary

This procedure involves injecting or infusing a neurolytic substance, such as alcohol, phenol, or iced saline solutions, into the epidural space around the lumbar or sacral regions of the spine. This is often done with or without the addition of other therapeutic substances to help manage chronic pain.

Purpose

The procedure is designed to alleviate chronic pain by interrupting nerve pathways. It is often used to treat conditions like chronic back pain, cancer-related pain, or severe nerve pain that has not responded to other treatments. The expected outcome is significant pain relief and improved quality of life.

Indications

• Chronic lower back pain
• Cancer-related pain
• Persistent nerve pain not relieved by conventional therapies
• Patients who have not responded well to other pain management treatments

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Specific medications may need to be adjusted or paused.
• Pre-procedure assessments often include a thorough medical history, physical examination, and possibly imaging studies like an MRI or CT scan.

Procedure Description

1. The patient lies on their abdomen or side.
2. The injection site is cleaned and sterilized.
3. Local anesthesia is administered to numb the area.
4. Using imaging guidance like fluoroscopy, a needle is carefully inserted into the epidural space in the lumbar or sacral region.
5. The neurolytic substance is injected or infused through the needle.
6. The needle is withdrawn, and the injection site is dressed.

Equipment used may include needles, syringes, imaging machines, and monitoring devices. Minimal sedation is usually required.

Duration

The procedure typically takes between 30 to 60 minutes.

Setting

This procedure is usually performed in a hospital, outpatient clinic, or a surgical center.

Personnel

• Pain management specialist or anesthesiologist
• Radiologist (if imaging guidance is used)
• Nurses and support staff

Risks and Complications

• Common risks: bleeding, infection, temporary increase in pain
• Rare risks: nerve damage, allergic reactions, paralysis
• Possible complications: hematoma, prolonged numbness or weakness

Benefits

• Significant pain relief
• Improved quality of life
• Reduced need for pain medications Benefits are often realized shortly after the procedure and can last for several weeks to months.

Recovery

• The patient may be monitored for a short time before being discharged.
• Post-procedure instructions may include rest, avoiding strenuous activities, and taking prescribed medications.
• Follow-up appointments are often scheduled to assess pain relief and address any concerns.

Alternatives

• Oral or injectable pain medications
• Physical therapy
• Surgical interventions
• Alternative pain management techniques, such as nerve blocks or spinal cord stimulation

Each alternative has its own set of pros and cons, which should be discussed with a healthcare provider.

Patient Experience

• Patients may feel a brief sting or pressure during the injection.
• Post-procedure discomfort is usually mild and manageable with prescribed pain medications.
• Most patients can resume normal activities within a few days, although strenuous activities should be avoided for a specified period.