Name of the Procedure:

Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar

Summary

This procedure involves the placement of an indwelling catheter for the continuous or intermittent administration of medications or diagnostic substances into the spinal area through the interlaminar space. It is used to manage pain and other conditions requiring direct delivery of medications near the spinal cord, excluding neurolytic substances that destroy nerve tissue.

Purpose

The procedure addresses:

• Chronic pain management.
• Management of spasticity and muscle spasms.
• Pain relief during and after surgeries.

The goals are:

• Relief of chronic pain.
• Improved mobility by reducing muscle spasms.
• Providing anesthetic effects during and after surgical procedures.

Indications

• Chronic back or neck pain.
• Severe muscle spasms or spasticity.
• Conditions like herniated discs, spinal stenosis, or post-surgical pain.
• Intractable pain not managed by other treatments.
• Pre-operative and post-operative pain control.

Preparation

• Patients may need to fast for several hours prior.
• Medication adjustments, such as stopping blood thinners.
• Diagnostic tests like MRI or CT scans to guide the procedure.
• Allergy tests for the medications to be used.

Procedure Description

1. Initial Preparation: The patient lies face down or on their side.
2. Anesthesia: Local anesthesia is applied to numb the area, with possible mild sedation.
3. Catheter Insertion: Using a needle, the physician inserts the catheter into the interlaminar space.
4. Medication Administration: Diagnostic or therapeutic substances are either continuously infused or intermittently injected through the catheter.
5. Monitoring: The patient is monitored to ensure proper dosage and placement.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

• Hospital or outpatient surgical center.

Personnel

• Anesthesiologist or pain specialist.
• Nurse or medical technician.
• Radiologist, if imaging guidance is needed.

Risks and Complications

• Common: Soreness at the injection site, mild headache, or nausea.
• Rare: Infection, bleeding, nerve damage, or spinal fluid leakage.

Benefits

• Significant pain relief.
• Reduced muscle spasms.
• Enhanced quality of life.
• Effects can be felt within minutes to a few hours post-procedure.

Recovery

• Patients may need to rest for a few hours after the procedure.
• Instructions may include avoiding strenuous activities for 24-48 hours.
• Follow-up appointments to monitor the effectiveness and adjust dosages.

Alternatives

• Oral or injectable pain medications.
• Physical therapy.
• Surgical options.
• Alternative pain management techniques such as nerve blocks.

Patient Experience

• Mild discomfort during the catheter insertion.
• Post-procedure, patients might feel immediate improvement in symptoms.
• Pain management strategies include prescribed medications and supportive care.