Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement).

Summary

This procedure involves placing a catheter near the brachial plexus—a network of nerves near the neck and shoulder—and using it for the continuous infusion of an anesthetic agent and/or steroid to provide long-term pain relief.

Purpose

The procedure addresses chronic pain or severe acute pain in the upper extremity (shoulder, arm, or hand). The goal is to offer sustained relief from pain, improve function, and reduce the need for systemic pain medication.

Indications

• Chronic pain conditions such as complex regional pain syndrome (CRPS)
• Post-operative pain management following shoulder or upper arm surgery
• Severe acute injuries to the upper extremity
• Conditions causing severe nerve pain unresponsive to oral medications

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Medication adjustments may be necessary, including discontinuing blood thinners.
• Pre-procedure assessments might include imaging studies (like an MRI) and blood tests.
• Patients should arrange for transportation, as they will not be able to drive post-procedure.

Procedure Description

1. The patient is positioned comfortably, usually lying down.
2. A local anesthetic is applied to numb the area where the catheter will be inserted.
3. Using ultrasound guidance or a nerve stimulator, the physician identifies the brachial plexus.
4. A thin catheter is inserted near the nerve cluster.
5. The catheter is secured in place, and an infusion pump is connected to deliver the anesthetic agent and/or steroid continuously.
6. The infusion rate can be adjusted as needed to manage the patient's pain.

Duration

The catheter placement procedure typically takes about 30 to 60 minutes. The infusion duration can range from several days to weeks, depending on the patient's needs.

Setting

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

Personnel

• Anesthesiologist or pain management specialist
• Nurses
• Anesthesia technician (optional)

Risks and Complications

• Infection at the insertion site
• Bleeding
• Nerve damage
• Allergic reactions to the anesthetic or steroid
• Catheter displacement or blockage
• Systemic absorption leading to toxicity

Benefits

• Long-term pain relief
• Improved upper extremity function
• Reduced need for oral pain medications
• Enhanced post-operative recovery and rehabilitation

Recovery

• Patients are monitored for a few hours post-procedure.
• Instructions on catheter care and use of the infusion pump are provided.
• Follow-up appointments may be scheduled to adjust the infusion rate or to remove the catheter.
• Most patients can resume light activities within a day but should avoid strenuous tasks.

Alternatives

• Oral pain medications (NSAIDs, opioids)
• Nerve blocks without continuous infusion
• Physical therapy
• Surgical interventions for pain relief
• Each alternative has its pros and cons in terms of efficacy, side effects, and duration of relief.

Patient Experience

• During the procedure, patients will feel minimal discomfort due to the local anesthetic.
• Post-procedure, they may experience numbness or tingling in the affected limb.
• Pain relief typically begins soon after the infusion starts.
• Pain management strategies and comfort measures are provided to ensure minimal discomfort.