Name of the Procedure:

Injection of Morphine Sulfate, Preservative-Free for Epidural or Intrathecal Use (HCPCS Code J2274)

Common Name(s): Epidural morphine injection, Intrathecal morphine injection
Technical Terms: Epidural morphine sulfate administration, Intrathecal morphine sulfate administration

Summary

This procedure involves injecting a preservative-free solution of morphine sulfate into the epidural or intrathecal space of the spine. It is used to manage severe, chronic pain or pain following surgery.

Purpose

Medical Conditions Addressed:

• Severe chronic pain conditions (e.g., cancer pain, pain from spinal injuries)
• Post-surgical pain management

Goals/Expected Outcomes:

• Alleviation of pain
• Improved quality of life
• Reduced need for systemic pain medication

Indications

Symptoms/Conditions:

• Persistent, severe pain that is unresponsive to other treatments
• Pain requiring immediate and long-term management

Patient Criteria:

• Patients suffering from severe chronic pain
• Postoperative patients needing effective pain relief
• Patients without contraindications for epidural or intrathecal injections

Preparation

Pre-Procedure Instructions:

• Fasting for at least 6-8 hours before the procedure if general anesthesia is planned
• Adjustments of current medications based on the healthcare provider’s recommendations
• Performing necessary diagnostic tests like MRI or CT scans to evaluate the spine

Procedure Description

1. Initial Preparation:

   • Patient positioned to expose the injection site.
   • Sterilization of the injection area.
   • Application of local anesthetic to numb the injection site.

2. Injection Process:

   • Insertion of a needle into the epidural or intrathecal space under sterile conditions.
   • Administration of the preservative-free morphine sulfate solution.

3. Monitoring:

   • Patient monitored for immediate response to the injection.

Tools and Equipment:

• Sterile injection kit
• Morphine sulfate, preservative-free
• Anesthesia monitoring equipment

Anesthesia/Sedation:

• Local anesthetic for site numbness; general anesthesia may be used in some cases.

Duration

The procedure typically takes about 30 to 60 minutes, including preparation and monitoring.

Setting

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

Personnel

• Anesthesiologist or Pain Specialist
• Nursing staff
• Potential involvement of a surgeon for intrathecal injections

Risks and Complications

Common Risks:

• Infection at the injection site
• Bleeding
• Headache

Rare Complications:

• Nerve damage
• Respiratory depression
• Allergic reaction to morphine

Management:

• Immediate medical intervention for any adverse reactions
• Antibiotics for infection
• Pain management for post-procedure discomfort

Benefits

• Significant pain relief, potentially within minutes to hours
• Decreased need for oral pain medications
• Enhanced overall well-being and ability to participate in daily activities

Recovery

Post-Procedure Care:

• Monitoring for a few hours to ensure no immediate complications
• Instructions on activity restrictions and signs of complications to watch for

Expected Recovery Time:

• Immediate to within a few days, depending on the patient's condition
• Follow-up appointments to monitor efficacy and adjust treatment if necessary

Alternatives

Other Treatment Options:

• Oral or systemic pain medications
• Physical therapy
• Other types of nerve blocks or injections
• Non-pharmacological pain management methods like acupuncture or TENS

Pros and Cons:

• Pros of Alternatives: Less invasive, fewer immediate risks
• Cons of Alternatives: May be less effective for severe pain, potential for systemic side effects

Patient Experience

During the Procedure:

• Minimal discomfort due to local anesthetic; possible pressure during needle insertion
• Sedation or general anesthesia may make the procedure unnoticeable

After the Procedure:

• Possible soreness at the injection site
• Potential rapid relief from pain
• Instructions provided for pain management and activity modifications to ensure comfort during recovery