64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)

Name of the Procedure:

Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
Common name: Paravertebral Sympathetic Nerve Block

Summary

In this procedure, an anesthetic agent is injected near the thoracic or lumbar spine to block nerve signals and provide pain relief. The aim is to alleviate chronic pain originating from the back, chest, or abdomen.

Purpose

The procedure is performed to:

• Relieve chronic pain in the lower back, chest, or abdomen
• Reduce nerve-related pain by numbing specific sympathetic nerves
  Expected outcomes include significant pain relief and improved quality of life.

Indications

This procedure is indicated for:

• Chronic pain conditions such as complex regional pain syndrome (CRPS)
• Persistent pain following surgeries or injuries in the thoracic/lumbar region
• Certain abdominal or chest pain syndromes Patients typically have not responded well to other pain management treatments.

Preparation

Patients should:

• Follow fasting guidelines, usually not eating or drinking for 6-8 hours before the procedure
• Discuss current medications with their doctor; certain medications may need to be paused
• Undergo diagnostic tests such as imaging (MRI, CT) to plan the injection site accurately

Procedure Description

1. The patient is positioned on their stomach.
2. The skin over the injection site is sterilized.
3. Local anesthesia is administered to numb the skin.
4. Using fluoroscopic (X-ray) guidance, a needle is inserted near the targeted sympathetic nerve.
5. An anesthetic agent is injected through the needle.
6. The needle is removed, and the injection site is covered with a sterile bandage.

Tools used:

• Fluoroscope for imaging guidance
• Sterile needles and syringes
• Anesthetic agents

Anesthesia:

• Local anesthesia is applied to the skin. In some cases, mild sedation may be used.

Duration

The procedure typically takes 30 to 45 minutes.

Setting

The procedure is performed in a hospital, outpatient clinic, or surgical center equipped with imaging facilities.

Personnel

• Pain management specialist or anesthesiologist
• Radiology technician (for imaging guidance)
• Nurse or medical assistant

Risks and Complications

Common risks:

• Soreness or bruising at the injection site
• Temporary numbness or weakness

Rare risks:

• Infection
• Bleeding
• Nerve damage
• Allergic reaction to the anesthetic

Benefits

Expected benefits include:

• Reduction in pain levels, often noticeable within a few hours to days
• Improved mobility and daily functioning
• Decreased need for oral pain medications

Recovery

Post-procedure care includes:

• Resting for the remainder of the day
• Avoiding strenuous activities for 24 hours
• Monitoring the injection site for signs of infection
• Follow-up appointment within 1-2 weeks to assess pain relief and plan further treatment

Alternatives

Other treatment options:

• Oral pain medications (e.g., NSAIDs, opioids)
• Physical therapy
• Other types of nerve blocks or injections
• Surgical interventions

Pros and Cons:

• Medications may provide short-term relief but can have side effects.
• Physical therapy is non-invasive but may be less effective for certain pain types.
• Surgical options might offer more lasting relief but come with higher risks and longer recovery times.

Patient Experience

During the procedure:

• Patients may feel a sting when the local anesthetic is injected.
• Some pressure may be felt when the needle is inserted near the nerve.

After the procedure:

• Temporary numbness and soreness at the injection site
• Pain relief typically begins within a few hours to days
• Comfort measures include ice packs and prescribed pain relievers for post-procedure soreness

Pain management and comfort are prioritized throughout the process to ensure patient well-being.