Treatment of Chronic Pain Conditions by Jason E. Pope & Timothy R Deer

Author:Jason E. Pope & Timothy R Deer
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Cardiorespiratory

Neurological

Hypotensiona

Nausea and anxietya

Bradycardiaa

Arm/hand dysaesthesia or paralysisa

Respiratory compromisea

High sensory level block

Apneaa

Cranial nerve involvement

Reduced oxygen saturation

Loss of consciousnessa

Difficulty speaking/coughing

Cardiac arrest (asystole)

Adapted from www.​totw.​anaesthesiologis​ts.​org

aCommonly reported or “classical”

Prevention of Intrathecal Injection

Prevention of injury is the most reliable means to assure the safety during image-guided pain interventions. The precise placement of the epidural needle with the assistance of fluoroscopic guidance is mandatory. Practitioners must learn to recognize the characteristic patterns of epidural and intrathecal contrast spread. It is also important to recognize unusual contrast patterns that signal subdural placement. During epidural steroid injection, it is wise to abort the procedure before placing steroid when either subdural or intrathecal needle position is suspected. The clinician should limit a single epidural bolus of anesthetic to the maximum reasonable dose to administer as a single intrathecal injection, particular at the cervical level. A resuscitation cart with adequate equipment and medication stored should be readily available; associated training and rehearsal should be regularly scheduled in preparation for this kind of emergent scenario.

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