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Destruction by neurolytic agent; other peripheral nerve or branch

CPT4 code

Name of the Procedure:

Destruction by Neurolytic Agent; Other Peripheral Nerve or Branch Common name(s): Neurolytic nerve block, Peripheral nerve neurolysis

Summary

Destruction by neurolytic agent is a medical procedure where substances such as alcohol, phenol, or other agents are injected to destroy a specific peripheral nerve or its branch. This helps interrupt pain signals, providing relief from chronic pain conditions.

Purpose

This procedure addresses chronic pain conditions, often due to nerve damage or other underlying issues. The main goal is to significantly reduce or eliminate pain, thereby improving the patient's quality of life.

Indications

  • Chronic, debilitating pain that has not responded to conservative treatments.
  • Conditions like neuropathic pain, neuralgia, or malignancy-related pain.
  • Patients who are not suitable candidates for surgical interventions.

Preparation

  • Patients may need to fast for a few hours before the procedure.
  • Medications may need to be adjusted; anticoagulants and anti-inflammatories might need to be paused.
  • Diagnostic imaging or nerve function tests may be conducted to precisely locate the nerve.

Procedure Description

  1. The patient is positioned comfortably, and the target area is cleaned.
  2. Local anesthesia is applied to the skin above the nerve to minimize discomfort.
  3. Using imaging guidance like ultrasound or fluoroscopy, a needle is inserted toward the target nerve.
  4. A neurolytic agent (e.g., alcohol or phenol) is carefully injected to destroy the nerve fibers.
  5. The needle is removed, and a bandage is applied to the injection site.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic, surgical center, or hospital interventional radiology suite.

Personnel

  • Interventional pain specialist or anesthesiologist
  • Nurse or medical assistant
  • Radiologist (if imaging guidance is used)

Risks and Complications

Common risks:

  • Temporary discomfort or pain at the injection site
  • Bruising or swelling Rare complications:
  • Infection
  • Nerve damage leading to weakness or loss of sensation
  • Allergic reaction to the neurolytic agent or anesthetic

Benefits

  • Significant pain relief
  • Improved ability to perform daily activities
  • Enhanced quality of life Benefits can typically be realized within a few days to a week.

Recovery

  • Patients can usually go home the same day.
  • Post-procedure care includes rest, avoiding strenuous activities, and taking prescribed pain management medications as needed.
  • Recovery time varies; most patients can resume normal activities within a few days to a week.
  • Follow-up appointments are often scheduled to monitor progress and address any concerns.

Alternatives

  • Physical therapy
  • Medications (pain relievers, anti-inflammatory drugs, antidepressants, anticonvulsants)
  • Other nerve blocks (using non-destructive agents)
  • Surgical interventions, like nerve decompression

Each alternative has its pros and cons, and the best option depends on the patient's specific condition and response to previous treatments.

Patient Experience

During the procedure, patients may feel a brief sting from the needle and some pressure as the agent is injected. After the procedure, patients might experience mild discomfort or soreness at the injection site, which can usually be managed with over-the-counter pain relievers and ice packs.

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