Epidural Steroid Injection: A Case Study

The practice of patient-controlled analgesia (PCA) has been around for approximately four decades now. During this time there have been improvements to the technology and the understanding of how to use this form of patient pain control; however, there continues to be concern related to the safety and efficacy of PCA. As this analysis proceeds it will briefly explain what PCA is and how it is used, then delve into the benefits and the safety issues surrounding PCA use as it pertains to the patient and the nurse. Some of the benefits of PCA include improved pain management, improved use of nursing resources, increased patient satisfaction, and reduced pulmonary issues (Hicks, Sikirica, Nelson, Schein & Cousins, 2008). Some of the safety

In 2014, more people died from drug overdoses then in any other year on record. A substantial amount of deaths were due to drug overdose on opioids, according to the CDC. (2015:64). In 1901, surgeon Racoviceanu-Pitesti published his first report on opioids for intrathecal anesthesia. In 1979, a report on the use of morphine as a treatment for pain was made, by Behar and his colleagues. Epidural and spinal opioids are today part of a routine regimen for intra- and postoperative anesthesia, according to Fisher (2003:683). Historically opioids have been used as painkillers, however the potential for misuse is huge; when these are used repeatedly, it increases the risk of developing an addiction. The use of illegal opiate drugs such as heroin

This has a capability of administering a constant delivery of a drug into the body. Sudden pain can be ceased instantly by the patients PCA.

They also mentioned prescribing some hypertensive and asthma medications are frequently refilled medications in the unit. In addition, they all agreed that the types of non-pharmacological treatment they prescribe the most are application of hot and cold compress if indicated, splinting, casting, canes and crutches for orthopedic issues.

According to the American Pregnancy organization “more than 50% of woman giving birth at hospitals use Epidural Anesthesia”. These women turn to epidural to relieve the pain of labor; however this decision poses many risks to both mother and child. An epidural is a type of regional anesthesia where pain medication is administered to the lumbar and sacral region of the back near clusters of nerves. The placement allows for nerve impulses to be blocked from the lower regions of the body resulting in decreased sensations. Although the epidural is known for taking pain away it could very well cause it too. Epidurals include the use of various narcotics and have side effects like hypotension, fever, fetal malposition, decreased fetal heart rate, respiratory depression, breastfeeding complications, an increased likelihood of operative vaginal delivery and cesarean and many more. These are the effects faced in result to a procedure that is not definite to work. In Fact “One in every 8 women” (OAA) will experience inadequate pain relief and must venture to other means of medication. Therefore, mothers should abstain from epidural anesthesia due to the risks it poses to themselves and to the fetus.

CA MTUS supports facet injections for non-radicular facet mediated pain. In addition, ODG criteria for facet injections include documentation of low-back pain that is non-radicular, failure of conservative treatment (including home exercise, PT, and NSAIDs) prior to the procedure for at least 4-6 weeks, no more than 2 joint levels to be injected in one session, and evidence of a formal plan of additional evidence-based activity and exercise in addition to facet joint therapy. This is an appeal to a previously denied request on 02/09/16. The latest note and the appeal letter stated that the reviewing doctor denied the joint injections because there was no documentation of ruling out radiculopathy. The bottom line is that this patient has MRI scan evidence of both disc pathology and facet arthropathy. It was noted that the patient has been symptomatic since 2005. He has continued back pain with a recent 10/12/15 date of

Wide range of medications are used to alleviate pain symptoms and carry out procedures depending on the nature of injury

UCF’s College of Medicine was recently recognized by the White House as one of 60 medical schools across the country to pledge to teach students about the dangers of prescribing opioids to patients for pain. The pledge follows President Obama’s public-private efforts to fight the nations epidemic of prescription opioid and heroin abuse, according to a press release from UCF.

“If they do not get better, it tells you that the pain is not coming through the sympathetic nervous system. That is what we call sympathetically independent pain. It’s treated with a spinal cord stimulator. That’s where put these little electrodes into the epidural space in the spine. We stimulate the pathways that block pain, pathways that transmit pain. We work to create a tingling sensation in the affected area. Hopefully, that tingling sensation is pleasant and blocks the pain and the patient feels

A physician with a wealth of experience in the fields of anesthesiology and pain management, Dr. Daniel Kendall has served as an interventional pain medicine specialist with National Spine and Pain Centers for 17 years. He treats patients out of National Spine and Pain’s Arlington location near his home town of Vienna, Virginia. Before assuming his current position, Dr. Daniel Kendall served as chief fellow of pain management at Johns Hopkins Hospital in Baltimore, Maryland. His experience with Johns Hopkins included training in advanced modalities such as sympathetic blocks, vertebroplasty, intrathecal pumps, IDET, radiofrequency ablation, and spinal cord stimulation.

This therapy may be used for a variety of pain and disability states especially involving the hands and feet.

The role of epidural steroid injections in the treatment of sciatica due to lumber disc herniation has generated much discussion and debate over the last 50 years and highly variable results have produced.

Recommendation was made for a left L5 transforaminal epidural steroid injection to see if this will help her pain more than the SI joint and piriformis trigger point injections. This would be for diagnostic purposes and potential therapeutic. She would like to schedule the injections.

The patient received a lumbar ESI at L5-S1 per procedure reports dated 06/02/15 and 08/25/15.

2. Impaired physical mobility R/T the joint pain planning and implementation includes: instruct the patient to perform movements when there is no pain; perform ambulate with the aid of mass by using a "walker" or a stick; perform ROM carefully.