Procedures

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Procedures

Caudal Epidural Injection

There is a small opening right at the base of your spine that permits easy access to the epidural space within the spine. This is called the Caudal (sacral) hiatus. Injecting into the epidural space using the Caudal hiatus is very safe, comfortable and effective compared to other types of epidural injection.

Caudal Injection

When only local anaesthetic is used, it is reasonable to assume that only short-term relief could possibly be obtained from the injection. In reality, the opposite seems to be the case. Epidural injections without cortisone can induce long-term pain relief. The epidural injection is injected into the epidural space. The spinal cord is enclosed within a sac of fluid, which is contained by a membranous layer called the dural sac. The epidural space is the space between this dural sac and the bony vertebral column.

Cervical Medial Branch Blocks

The medial branch nerves are small nerves (not much thicker than a piece of cotton) which provide the feeling to the facet joints at the back of the spine. They also give movement to a small patch of muscle directly above the joint. Placing a drop or two of local anaesthetic onto the nerve causes it to stop working temporarily (thus 'blocking' it from transmitting signals). If the medial branch nerve is blocked, you can't feel what is going on the in the facet joints.

Cervical Radiofrequency Lesioning

Pain arising from the small joints of the neck (facet joints or zygopophyseal joints) can be diagnosed by blocking the nerve supply to these joints using local anaesthetic. These nerves are known as the Medial branches. Blocking them is therefore known as Medial Branch Block (MBB). If this local anaesthetic (diagnostic) injection has been of some benefit even for a limited time, it strongly suggests that the pain is arising from these small joints. The procedure which blocks these nerves for a significantly longer period using an electrical energy source is known as radio frequency lesioning. Other terms for the same procedure are Radiofrequency Denervation or Radiofrequency Neurotomy.

Cluneal Nerve Blockade

To better understand cluneal nerve blocks it is important to understand the cluneal nerve. This nerve cluster is at the upper portion of the buttocks and is the termination of the lumbar nerves at the base of the spine.

Cluneal Nerve Stimulation

You have probably had many treatments for your pain, most of which will have been of little or no help. This surgical procedure works by targeting one or more nerves, which are transmitting most of the pain. We introduce a small amount of electrical current to these nerves, which helps to mask the pain that you are feeling. This procedure is ordinarily non-destructive and reversible.

Ganglion Impar Block

A ganglion impar block is a procedure used to decrease some of the symptoms of persistent pelvic or rectal pain by blocking nerve impulses.

Ganglion Impar Pulsed Radio Frequency

The ganglion impar block has been shown to relieve chronic perineal pain nonresponsive to any conservative treatment. This unpaid sympathetic ganglion is located in the retroperitoneal midline at the level of sacrococcygeal junction. Pulsed radiofrequency utilises a pulsed current at approximately 42 degrees centigrade for a period of 4-6 minutes, which does not result in sufficient tissue injury. Fluoroscopically guided ganglion impar block and pulsed radiofrequency may offer a safe and effective way of improving non-cancer perineal pain.

Implanted Spinal Pump for the Management of Pain

An implanted pump is an Implanted Intrathecal Drug Delivery System that releases pain-relieving medication through a catheter directly to the intrathecal space surrounding the spinal cord where pain signals travel, interrupting pain signals before they reach the brain. Intrathecal drug delivery uses an infusion system to manage severe persistent pain.

Ketamine Infusion

Ketamine is a highly specialised pain management drug. It was invented in the 1960s for use in anaesthesia. These days it is mainly used in disaster relief or emergency anaesthesia. Vets often use it as an anaesthetic agent. Its use in the management of chronic pain arose when people recovering from anaesthesia who had chronic pain reported improvements in their pain, which lasted sometimes for months following the ketamine anaesthesia.

Lumbar Medial Branch Block

The medial branch nerves are small nerves (not much thicker than a piece of cotton) that provide the feeling to the facet joints at the back of the spine. They also give movement to a small patch of muscle directly above the joint. Placing a drop or two of local anaesthetic onto the nerve causes it to stop working temporarily (thus 'blocking' it from transmitting signals). If the medial branch nerve is blocked, you can't feel what is going on the in the facet joints.

Lumbar Sympathetic Block

A lumbar sympathetic block is an injection of local anesthetic into or around the sympathetic nerves. These sympathetic nerves are a part of the sympathetic nervous system. The nerves are located on the either side of spine, in the lower back. Normally these nerves control basic functions like regulating blood flow. In certain conditions, these sympathetic nerves can carry pain information from the peripheral tissues back to the spinal cord.

Lumbar Thoracic Radiofrequency Lesioning

Pain arising from the small joints of the upper or middle of the back (facet joints or zygopophyseal joints) can be diagnosed by blocking the nerve supply to these joints using local anaesthetic. These nerves are known as the medial branches. Blocking them is therefore known as medial branch block. If this local anaesthetic (diagnostic) injection has been of some benefit even for a limited time, it strongly suggests that the pain is arising from these small joints. The procedure, which blocks these nerves for a significantly longer period using an electrical energy source, is known as Radiofrequency Lesioning. Other terms for the same procedure are Radiofrequency Denervation or Radiofrequency Neurotomy.

Nerve Root Sleeve Injection (Transforaminal Injection)

At each level in the spine, a nerve emerges which goes out to supply nerve impulses to various body regions, including skin, muscle and organs. The area of the nerve as it emerges is called the nerve root. Each nerve root is surrounded by a little tunnel of connective tissue called the nerve root sleeve. Inside the nerve root sleeve is continuous with the epidural space of the spine, so an injection, which places medicines inside this tunnel, is effectively a type of epidural injection. A nerve root sleeve injection places a small amount of local anaesthetic and cortisone-type medication into the nerve root sleeve.

Peripheral Nerve Pulsed Radio Frequency

PRF is a treatment for nerve pain or localised pain in the body caused by irritation or malfunction of a nerve or sensitization of the pain system. It is performed in an operating theatre under light sedation by a pain specialist.

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