Name of the Procedure:

Injection, Ziconotide, 1 Microgram (J2278)
Common names: Ziconotide injection, Intrathecal ziconotide injection
Medical term: Intrathecal administration of ziconotide

Summary

Intrathecal ziconotide injection is a procedure where a tiny amount of ziconotide is injected directly into the cerebrospinal fluid surrounding the spinal cord. This helps manage severe, chronic pain that has not responded to other treatments.

Purpose

The aim of this procedure is to provide pain relief for individuals with severe, chronic pain, especially when other pain management treatments or medications have been ineffective. It seeks to improve the patient’s quality of life by reducing pain intensity.

Indications

• Severe, chronic pain that has not been adequately managed by oral medications or other interventions.
• Pain related to cancer or AIDS.
• Neuropathic pain (pain caused by nerve damage or dysfunction).

Preparation

• Prior to the procedure, patients may be asked to fast for a few hours.
• Certain medications may need to be adjusted or temporarily discontinued.
• A thorough medical history and physical examination will be conducted.
• Imaging studies like MRI or CT scans may be required to assess the spinal area.

Procedure Description

1. The patient is placed in a comfortable position, usually lying on their side with knees drawn up.
2. The injection site is cleaned with an antiseptic solution.
3. A local anesthetic may be administered to numb the injection area.
4. Using a fine needle, a specific dose of ziconotide is injected into the cerebrospinal fluid of the lower spine.
5. The injection process is carefully monitored to ensure accuracy and patient safety.
6. The needle is withdrawn, and a small bandage is applied to the site.

Duration

The procedure typically takes about 30 minutes to complete, including preparation and recovery time.

Setting

Intrathecal ziconotide injections are usually performed in a hospital, outpatient clinic, or specialized pain center.

Personnel

• Pain management specialists
• Anesthesiologists (if sedation is required)
• Nurses
• Medical assistants

Risks and Complications

Common risks:

• Headache
• Nausea
• Dizziness
• Site pain or infection

Rare risks:

• Severe allergic reaction
• Difficulty breathing
• Muscle weakness
• Seizures

Benefits

The primary benefit is the potential for significant pain relief in patients with chronic, intractable pain. Positive effects can often be felt within hours to days after the injection.

Recovery

• Patients should rest for a few hours after the procedure.
• Avoid strenuous activities for at least a day.
• Follow-up appointments may be scheduled to monitor pain levels and adjust medication dosages.

Alternatives

• Oral pain medications (opioids, NSAIDs)
• Other intrathecal pump therapies
• Spinal cord stimulation
• Physical therapy and non-invasive pain management techniques

Pros and cons of alternatives:

• Oral medications may be less invasive but often less effective for severe pain.
• Spinal cord stimulation offers another invasive option but may not be suitable for all patients.

Patient Experience

During the procedure, patients may feel a slight pressure or pinch at the injection site. Post-procedure, localized soreness is common, but significant pain is typically minimal. Pain management is closely monitored, and any discomfort can be effectively managed with prescribed medications.