TiffianyEdwards
Networker
Does anyone have any resources for learning pain management and RA procedures. I am coding multple spec's and pain management I am so lost on what I am reading.
Planned Procedure: Radiofrequency ablation of the Right C4-5 C5-6, and C6-7 facet joints, C4,C5,C6,C7 medial branch nerves
Levels: Right C4, C5, C6 and C7 For the Right C4-5, C5-6 and C6-7 facet joints
The C4 and C5 medial branch nerves innervate the C4-5 facet joint
The C5 and C6 medial branch nerves innervate the C5-6 facet joint
The C6 and C7 medial branch nerves innervate the C6-7 facet joint
Pre/Post-Procedure Diagnosis:
1. Cervical spondylosis IR Paravertebral Facet Joint Neurolysis 1 Facet Cervical Thoracic Right
IR Paravertebral Facet Joint Neurolysis 1 Facet Cervical Thoracic Right
Informed Consent: The patient's condition and proposed procedures, risks, benefits and alternatives were discussed with the patient in detail. All questions were answered in detail and the patient chose to proceed. Informed consent was obtained.
Time Out: A time out verifying correct patient, medical record number, allergies and surgical site was performed immediately prior to beginning the procedure.
IV: Peripheral IV access was obtained. A 22g IV was placed in the patient's hand
.
Sedation: Versed 1 mg Fentanyl 50mcg
HPI: Ms. Wilkinson is a 53 y.o. female who presents with neck, upper back and shoulder pain. Previous treatment has included Medial branch blocks Helped. The patient reports >50% benefit from these blocks.
Procedure Description: The patient was placed in the prone position and made comfortable on pillows. Pulse oximetry and noninvasive blood pressure cuff were monitored throughout the case.
The skin of the neck was prepped with ChloraPrep and draped in sterile fashion. C-arm fluoroscopy was used to obtain a AP view in order to facilitate a AP approach to the target points at the midpoint of the 2 vertices of the quadrangle of the articular pillars on lateral view and the midway between the superior and inferior articular surfaces of the vertebrae at the "waist" of the pillar in AP view. The skin puncture sites were anesthetized with 2 mL 1 % Lidocaine. A 50 mm radiofrequency canula was used. The cannula was advanced advancement, at each level, using AP and lateral fluoroscopic guidance. Final needled positioning was performed in the lateral fluoroscopic view and the cannulas were advanced to the target point. In the case of the third occipital nerve, two radiofrequency cannulas were placed slightly superior and inferior to the C2-3 facet joint in lateral view. Confirmed needle tip on bone. Once all needles were considered to be in a satisfactory fluoroscopic position, sensory and motor stimulation was performed. Sensory stimulation was performed at 50 hertz, and was considered positive if pain was reproduced in a concordant fashion at a voltage at less than 1 millivolts. With motor stimulation, the goal was to see the absence of radicular upper extremity motor twitching or pain at the voltage greater than three times the magnitude of the sensory threshold. Specific parameters are available for review in the chart. This was performed for all levels. After satisfactory sensory and motor stimulation was complete, 0.5mL of 2% Lidocaine was placed through each needle. Lesioning was then performed at 80 degrees Celsius for 90 seconds at each level. The patient tolerated the procedure well. All needles were removed and Band-Aids were placed.
No immediate complications were observed.
C4: Sensory 1.6 Motor 3
C5: Sensory 1.2 Motor 2.0
C6: Sensory .5 Motor 1.5
C7; Sensory .7 Motor 1.5
Outcome: Patient's pain score was 7/10 before the procedure and 5/10 after the procedure. After meeting discharge criteria, the patient was discharged home with her escort/driver.
Impression/Follow-Up: XXXXXXX will follow up in 4 week to decide on the longer-term effects of today's procedure and consider RFA of the left at that time. She was instructed to call immediately if any of the following develops: new upper extremity neurologic symptoms, fever, worsening pain, headache, or any other symptoms
Planned Procedure: Radiofrequency ablation of the Right C4-5 C5-6, and C6-7 facet joints, C4,C5,C6,C7 medial branch nerves
Levels: Right C4, C5, C6 and C7 For the Right C4-5, C5-6 and C6-7 facet joints
The C4 and C5 medial branch nerves innervate the C4-5 facet joint
The C5 and C6 medial branch nerves innervate the C5-6 facet joint
The C6 and C7 medial branch nerves innervate the C6-7 facet joint
Pre/Post-Procedure Diagnosis:
1. Cervical spondylosis IR Paravertebral Facet Joint Neurolysis 1 Facet Cervical Thoracic Right
IR Paravertebral Facet Joint Neurolysis 1 Facet Cervical Thoracic Right
Informed Consent: The patient's condition and proposed procedures, risks, benefits and alternatives were discussed with the patient in detail. All questions were answered in detail and the patient chose to proceed. Informed consent was obtained.
Time Out: A time out verifying correct patient, medical record number, allergies and surgical site was performed immediately prior to beginning the procedure.
IV: Peripheral IV access was obtained. A 22g IV was placed in the patient's hand
.
Sedation: Versed 1 mg Fentanyl 50mcg
HPI: Ms. Wilkinson is a 53 y.o. female who presents with neck, upper back and shoulder pain. Previous treatment has included Medial branch blocks Helped. The patient reports >50% benefit from these blocks.
Procedure Description: The patient was placed in the prone position and made comfortable on pillows. Pulse oximetry and noninvasive blood pressure cuff were monitored throughout the case.
The skin of the neck was prepped with ChloraPrep and draped in sterile fashion. C-arm fluoroscopy was used to obtain a AP view in order to facilitate a AP approach to the target points at the midpoint of the 2 vertices of the quadrangle of the articular pillars on lateral view and the midway between the superior and inferior articular surfaces of the vertebrae at the "waist" of the pillar in AP view. The skin puncture sites were anesthetized with 2 mL 1 % Lidocaine. A 50 mm radiofrequency canula was used. The cannula was advanced advancement, at each level, using AP and lateral fluoroscopic guidance. Final needled positioning was performed in the lateral fluoroscopic view and the cannulas were advanced to the target point. In the case of the third occipital nerve, two radiofrequency cannulas were placed slightly superior and inferior to the C2-3 facet joint in lateral view. Confirmed needle tip on bone. Once all needles were considered to be in a satisfactory fluoroscopic position, sensory and motor stimulation was performed. Sensory stimulation was performed at 50 hertz, and was considered positive if pain was reproduced in a concordant fashion at a voltage at less than 1 millivolts. With motor stimulation, the goal was to see the absence of radicular upper extremity motor twitching or pain at the voltage greater than three times the magnitude of the sensory threshold. Specific parameters are available for review in the chart. This was performed for all levels. After satisfactory sensory and motor stimulation was complete, 0.5mL of 2% Lidocaine was placed through each needle. Lesioning was then performed at 80 degrees Celsius for 90 seconds at each level. The patient tolerated the procedure well. All needles were removed and Band-Aids were placed.
No immediate complications were observed.
C4: Sensory 1.6 Motor 3
C5: Sensory 1.2 Motor 2.0
C6: Sensory .5 Motor 1.5
C7; Sensory .7 Motor 1.5
Outcome: Patient's pain score was 7/10 before the procedure and 5/10 after the procedure. After meeting discharge criteria, the patient was discharged home with her escort/driver.
Impression/Follow-Up: XXXXXXX will follow up in 4 week to decide on the longer-term effects of today's procedure and consider RFA of the left at that time. She was instructed to call immediately if any of the following develops: new upper extremity neurologic symptoms, fever, worsening pain, headache, or any other symptoms