Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement)
CPT4 code
Name of the Procedure:
Injection(s), Anesthetic Agent(s) and/or Steroid; Femoral Nerve, Continuous Infusion by Catheter (Including Catheter Placement)
Summary
This procedure involves inserting a catheter near the femoral nerve to deliver continuous anesthetic or steroid medication. It's designed to provide pain relief, commonly for post-operative pain management or certain chronic pain conditions.
Purpose
- Medical Condition or Problem: Used to manage pain, particularly following surgeries such as knee replacement or hip surgery, and for chronic pain conditions.
- Goals/Expected Outcomes: To reduce pain and improve patient comfort, enabling faster recovery and greater mobility post-surgery.
Indications
- Severe pain following lower limb surgeries like knee or hip replacements.
- Chronic pain conditions affecting the femoral nerve or surrounding areas.
- Patients who require prolonged pain relief beyond what single injections can provide.
Preparation
- Pre-Procedure Instructions: Patients may need to fast for several hours before the procedure. Medication adjustments, such as stopping blood thinners, may be required.
- Diagnostic Tests: Blood tests, imaging studies, or nerve assessments may be conducted to plan the procedure accurately.
Procedure Description
- Positioning: The patient is typically positioned lying flat on their back.
- Anesthesia: Local anesthesia is applied to the skin where the catheter will be inserted. Sedation may be used for patient comfort.
- Insertion: A needle is guided near the femoral nerve using ultrasound or fluoroscopic imaging for precise placement.
- Catheter Placement: A catheter is threaded through the needle and secured in place.
- Medication Delivery: Anesthetic or steroid medication is continuously infused through the catheter to provide ongoing pain relief.
Tools and Technology: Ultrasound machine or fluoroscope, catheter, infusion pump, needles.
Duration
The procedure typically takes about 30-60 minutes.
Setting
The procedure is usually performed in a hospital, outpatient surgical center, or specialized pain management clinic.
Personnel
- Anesthesiologist or pain management specialist (performing the procedure)
- Nurse (assisting and monitoring)
- Radiologic technologist (if imaging is used)
Risks and Complications
- Common Risks: Infection at the insertion site, bleeding, and catheter dislodgement.
- Rare Risks: Nerve damage, allergic reactions, and systemic absorption of anesthetic leading to toxicity.
- Management: Complications are managed with antibiotics for infection, compressive dressings for bleeding, and monitoring for signs of nerve damage.
Benefits
- Significant pain relief, often immediate and prolonged.
- Reduced need for oral pain medications.
- Enhanced ability to participate in post-surgical rehabilitation.
Recovery
- Post-Procedure Care: The catheter site must be kept clean and dry. Monitor for signs of infection.
- Expected Recovery Time: Most patients experience pain relief within hours. Full recovery and catheter removal depend on individual pain management needs, generally within a few days to a week.
- Restrictions: Limited movement to avoid dislodging the catheter, follow-up appointments to monitor pain levels and adjust medication.
Alternatives
- Oral or intravenous pain medications.
- Single injection nerve blocks.
Physical therapy and other non-invasive pain management techniques.
Pros and Cons: Continuous infusion by catheter provides more consistent and often more effective pain relief compared to oral medications and single injections, but it involves the risks associated with catheter placement.
Patient Experience
- During the Procedure: Mild discomfort from the needle insertion and local anesthesia. Sedation may be given for enhanced comfort.
- After the Procedure: Continuous pain relief, reducing the need for additional pain medications. Some mild soreness around the catheter site is normal.
- Pain Management: Pain from the surrounding surgical area should be markedly reduced, improving overall comfort and mobility.