Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar
CPT4 code
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 placing a catheter in the space between the layers of tissue surrounding the spinal cord to deliver medication directly into the spinal area. Such medications can be given continuously or in separate doses.
Purpose
The procedure is intended to manage pain, reduce inflammation, or provide anesthesia. It targets conditions such as chronic pain, muscle spasms, and can be used as part of anesthesia for surgeries.
Indications
- Chronic back or neck pain
- Muscle spasms
- Inflammatory conditions
- Requirement for regional anesthesia during surgery
- Pain management in cancer patients
Preparation
- Fasting may be required for several hours before the procedure.
- Adjustments to certain medications (e.g., blood thinners) might be needed.
- Baseline diagnostic tests like blood work or MRI may be requested.
Procedure Description
- The patient is positioned usually lying down on their side or stomach.
- The procedure site is cleaned and sterilized.
- Local anesthesia is applied to numb the area.
- Using fluoroscopic (X-ray) guidance, a needle is inserted into the interlaminar space.
- A catheter is then threaded through the needle into the spinal area.
- The medication is delivered via the catheter either as a continuous infusion or intermittent boluses.
- The needle is removed, and the catheter is secured in place if continuous infusion is necessary.
Tools and equipment:
- Needle
- Catheter
- Fluoroscope
- Medication (anesthetic, opioid, steroid, etc.)
- Local anesthetic
Duration
The procedure generally takes between 30 to 60 minutes.
Setting
- Hospital
- Outpatient clinic
- Surgical center
Personnel
- Physician specializing in pain management or anesthesiology
- Nurse or medical assistant
- Radiology technician (if fluoroscopy is used)
Risks and Complications
- Infection
- Bleeding
- Nerve damage
- Allergic reaction to medication
- Catheter displacement
- Spinal headache
Benefits
- Significant pain relief
- Reduced inflammation
- Improved quality of life
- Enhanced mobility
- Pain relief may be immediate or take a few days to become effective
Recovery
- Rest for the remainder of the day post-procedure.
- Avoid strenuous activities for a few days.
- Follow-up appointments to monitor progress and catheter position if continuous infusion.
Alternatives
- Oral pain medications
- Physical therapy
- Epidural steroid injections
- Nerve blocks
- Surgery (for structural issues)
Pros and cons of alternatives:
- Oral medications may be less invasive but can have systemic side effects.
- Physical therapy is non-invasive but may not provide immediate pain relief.
- Surgery can address structural problems but carries higher risks and a longer recovery.
Patient Experience
- During the procedure: mild discomfort or pressure at the site of needle insertion.
- Post-procedure: possible temporary increase in pain, soreness, or tenderness at the injection site.
- Pain management: local anesthesia during the procedure, follow-up pain medications if needed.
- Comfort measures: rest and application of ice packs if soreness occurs post-procedure.