Complications of Interventional Pain Management Techniques

2014 ◽  
pp. 525-539
Author(s):  
Marco Araujo ◽  
Dermot More O’Ferrall
Keyword(s):  
Pain Management ◽  
Interventional Pain Management ◽  
Management Techniques

Interventional pain management techniques for chronic pain

2013 ◽  
pp. 474-485
Author(s):  
Navil F. Sethna ◽  
Pradeep Dinakar ◽  
Karen R. Boretsky
Keyword(s):  
Chronic Pain ◽  
Pain Management ◽  
Case Series ◽  
Pain Syndrome ◽  
Treatment Modalities ◽  
Neuraxial Blockade ◽  
Paediatric Case ◽  
Injection Techniques ◽  
Interventional Pain Management ◽  
Management Techniques

As part of multidisciplinary management of paediatric chronic pain, interventional pain management techniques can play an important role when pain is unrelieved by conventional treatment modalities. Many procedures and indications are extrapolated from adult studies, and evidence for long-term efficacy in paediatric populations is limited. Interventions range from injection techniques with local anaesthetic and/or corticosteroids to neuraxial blockade with implanted catheters. Paediatric case series have reported benefit in selected patients with complex regional pain syndrome and cancer-related pain.

Needle Placement

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Teresa M. Kusper
Keyword(s):  
Pain Management ◽  
Needle Placement ◽  
Short Summary ◽  
Injection Techniques ◽  
Interventional Pain Management ◽  
Management Techniques ◽  
Safety Considerations ◽  
Contrast Flow ◽  
Selection Of ◽  
The Ideal

Interventional pain management techniques are invaluable in the treatment of pain from various etiologies. Routine and advanced interventional pain management needle placement is essential not only to guarantee success with intended pain-relieving procedures, but also to minimize known complications from these same procedures. Knowledge of relevant anatomy is crucial. The focus of this chapter is to provide a brief description of various interventional pain management injection techniques. A short summary of the relevant anatomy, landmarks used for needle placement and important safety considerations is provided along with a selection of digital and radiographic photographs depicting the ideal needle placement and contrast flow at or in the immediate proximity of the targeted structures.

Growth of Spinal Interventional Pain Management Techniques

Spine ◽  
2013 ◽  
Vol 38 (2) ◽  
pp. 157-168 ◽  
Author(s):  
Laxmaiah Manchikanti ◽  
Vidyasagar Pampati ◽  
Frank J. E. Falco ◽  
Joshua A. Hirsch
Keyword(s):  
Pain Management ◽  
Interventional Pain Management ◽  
Management Techniques

scholarly journals Mid Atlantic Spine & Pain Physicians, Newark, DE; 1,5-8 Temple University Hospital, Philadelphia, PA

2012 ◽  
Vol 6;15 (6;12) ◽  
pp. E955-E968
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Pain Management ◽  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Online Survey ◽  
Warfarin Therapy ◽  
Practice Patterns ◽  
Bleeding Complications ◽  
Thromboembolic Events ◽  
Interventional Pain Management ◽  
Management Techniques

Background: The role of antithrombotic therapy is well known for its primary and secondary prevention of cardiovascular disease by decreasing the incidence of acute cerebral, cardiovascular, peripheral vascular, and other thrombotic events. The overwhelming data show that the risk of thrombotic events is significantly higher than that of bleeding during surgery after antiplatelet drug discontinuation. It has been assumed that discontinuing antiplatelet therapy prior to performing interventional pain management techniques is a common practice, even though doing so may potentially increase the risk of acute cerebral and cardiovascular events. There are no data available concerning these events, specifically in relation to the occurrence of thromboembolic events, even though some data are available concerning bleeding complications. Even then, interventionalists seem to routinely discontinue all antithrombotic therapy prior to all interventional pain management techniques. Objective: To assess the perioperative antiplatelet and anticoagulant practice patterns of US interventional pain management physicians as well as adverse events in patients on antithrombotic therapy who undergo interventional pain management techniques when that therapy is continued or stopped. Study Design: An online survey of interventional pain management physicians. Study Setting: Interventional pain management practices in the United States. Methods: An online survey was commissioned among 2,300 members of the American Society of Interventional Pain Physicians. The survey was designed to assess practice patterns and complications encountered. Results: Of the 2,300 members surveyed, 325 responded. These results showed that all physicians discontinued warfarin therapy; whereas, 97% discontinued clopidogrel; 96% ticlopidine; 95% Aggrastat (tirofiban); 93% cilostazol, 85% dipyridamole, 60% aspirin 350 mg; 39% aspirin 81 mg; and 39% other nonsteroidal anti-inflammatory drugs (NSAIDs) prior to performing interventional pain management techniques. The majority of physicians accepted an international normalized ratio of 1.5 or less as a safe level. An assessment of serious complications showed thromboembolic events were 3 times more frequent than bleeding complications: 162 thromboembolic events and 55 serious bleeding complications from epidural hematomas. Thromboembolic complications were severe and higher when antiplatelet therapy was discontinued. Bleeding complications from epidural hematomas were similar whether antiplatelet therapy was continued or discontinued (26 versus 29). Limitations: This study was limited by its being an online survey of the membership of one organization in one country and that there was a 14% response rate. Underreporting in surveys is common. Further, the incidence of thromboembolic events or epidural hematomas may be misrepresented as a percentage since these drugs were continued in a very small percentage of patients. Consequently, the incidences described in this manuscript may not show appropriate percentages. Conclusion: The results illustrate an overwhelming pattern of discontinuing antiplatelet and warfarin therapy as well as aspirin and other NSAIDs prior to performing interventional pain management techniques. However, thromboembolism complications may be 3 times more prevalent than epidural hematomas (162 versus 55 events). It is concluded that clinicians must balance the risks of thromboembolism and bleeding in each patient prior to the routine discontinuation of antiplatelet therapy. Key words: Interventional pain management, interventional techniques, hemostasis, anticoagulants, antiplatelet therapy, thromboembolic events, bleeding, complications, aspirin, clopidogrel (Plavix), warfarin (Coumadin).

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