# Lumbar Intrathecal Injection Opioid Trail



## SCCL5558 (Dec 3, 2013)

I am completely lost with this one. I am hoping that you all can help!! The provider was also questioning whether he can bill for the additional 6-8 hours that the patient was held for assessment of pain after the procedure???




PROCEDURE:	Lumbar intrathecal injection opioid trial
Injection # 1
Series # 1 
PREPROCEDURE DIAGNOSIS:  	Myeloma, multiple thoracic vertebral fractures and breast mass
POSTPROCEDURE DIAGNOSIS: 	Same.  

ANESTHESIA:	None

NEEDLE:	Spinal 25 gauge, 3.5 inch 

IV FLUIDS:	Heparin lock placed

CONTRAST DYE:	None.

INJECTED SOLUTION:	Duramorph 0.3 mg

ADDITIONAL MEDICATIONS:	None.

ESTIMATED BLOOD LOSS:	None.

COMPLICATIONS: 	None. 

OUTCOME: 				Good.  

INFORMED CONSENT:
The patient's condition, proposed procedures, risks, and alternatives were discussed and 
informed consent was obtained.  

PROCEDURE:
An IV was placed in the preoperative area. The patient was taken to the fluoroscopy suite and placed in a sitting position.  The skin overlying the injection site was prepped and draped in an aseptic fashion.  The lumbar vertebral interspace at L4-5 was identified palpation and landmarks. A procedural pause was performed.  

The skin and subcutaneous tissues overlying the target site of injection was anesthetized using 1% lidocaine MPF utilizing a 25-gauge 1-inch needle.  The needle was advanced into the intrathecal space with free flow of CSF.  Paresthesias were not noted with final needle positioning.  
Aspiration of CSF from the 0.3 to 1.0 ml was performed then the solution was slowly injected.  The needle was then removed.  Sterile bandages were placed over the injection site. 
The heart rate, pulse oximetry, and blood pressure were monitored intermittently though the day and the patient remained in the ASC holding area for 6-8 hrs with assessment of pain relief and development of any side effects.  The patient tolerated the procedure well.  The patient was in stable condition and after meeting discharge criteria was discharged home following the time observation. 

Today we performed a lumbar intrathecal opioid trial.  The goal in performing a intrathecal trial is to provide relief from pain and permit greater function with fewer side effects than oral or intravenous opioids.  If effective we will anticipate implantation of a intrathecal pump for continuous and intermittent delivery of intrathecal medications for pain relief. 
The patient was informed that the intrathecal opioid would be effective for 12-24 hrs and usual medications should be restarted as her pain increases.


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## marvelh (Dec 3, 2013)

62311 - it appears to be a single injection lumbar intralaminar intrathecal injection


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