64420 Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level

Name of the Procedure:

Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level

Summary

This procedure involves injecting an anesthetic or steroid medication near the intercostal nerves, which are situated between the ribs. It is typically done to relieve pain in the chest or upper abdominal area.

Purpose

The primary purpose of this procedure is to alleviate pain originating from the intercostal nerves. This type of pain may be due to conditions such as rib fractures, shingles (herpes zoster), or postoperative discomfort. The goal is to reduce pain and improve the patient's quality of life and functionality.

Indications

• Persistent or severe pain along the ribs or upper abdomen.
• Conditions like rib fractures or shingles that cause neuralgia.
• Pain that has not responded to other treatments such as oral medications or physical therapy.
• Candidates for the procedure are typically those who have been evaluated and recommended by a healthcare provider, often after imaging studies or diagnostic tests confirm the source of pain.

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Medication adjustments, especially for blood thinners or anticoagulants, may be necessary.
• Diagnostic tests such as MRI, CT scans, or X-rays might be required to identify the precise location of the nerve pain.

Procedure Description

1. The patient is positioned comfortably, usually lying on their side or stomach.
2. The skin over the injection site is cleaned and sterilized.
3. A local anesthetic may be administered to the skin and underlying tissues to minimize discomfort.
4. Using fluoroscopic (X-ray) guidance, the doctor inserts a fine needle near the affected intercostal nerve.
5. An anesthetic agent and/or steroid medication is injected directly around the nerve.

6. The needle is carefully removed, and a small bandage is applied to the injection site.

   Duration

   The entire procedure generally takes 20 to 30 minutes.

Setting

This procedure is typically performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Interventional pain specialist or anesthesiologist.
• Radiologic technologist (if imaging guidance is used).
• Nursing staff for patient preparation and monitoring.

Risks and Complications

Common risks include:

• Minor bleeding or bruising at the injection site.
• Temporary increase in pain. Rare risks include:
• Infection.
• Nerve damage.
• Allergic reaction to the medication. Complications are managed with appropriate medical care, and patients are closely monitored during and after the procedure.

Benefits

• Significant pain relief which can be immediate or might take a few days to manifest.
• Improved ability to perform daily activities.
• Reduction or elimination of the need for oral pain medications.

Recovery

• Post-procedure, patients are usually observed for a short period and can go home the same day.
• Mild soreness at the injection site may occur and can be managed with over-the-counter pain relievers.
• Patients are advised to avoid strenuous activities for 24-48 hours.
• Follow-up appointments may be necessary to assess the effectiveness of the injection and determine if further treatments are needed.

Alternatives

• Oral pain medications.
• Nerve blocks.
• Physical therapy.
• Surgical options in severe cases. Each alternative has its own pros and cons, and the choice depends on the patient’s specific condition and overall health.

Patient Experience

During the procedure, the patient may feel slight pressure or discomfort when the needle is inserted. Local anesthetic helps minimize pain. Post-procedure, mild soreness is common, but most patients report significant pain relief within a few days. Pain management techniques and comfort measures are employed to ensure patient comfort throughout the process.