Interventional Pain Management Flashcards
Superior hypogastric block improves pain in which areas? What type of pain?
Peritoneum
Genitals
Useful for GYN cancer
Pain that is REFRACTORY to medical management
Good for VISCERAL pain
This is a SYMPATHETIC block
Stellate ganglion block improves pain in which areas? What type of pain?
Neck
Good for VISCERAL pain
This is a SYMPATHETIC block
Ganglion pars block improves pain in which areas? What type of pain?
Pelvic but back towards rectum
Good for VISCERAL pain
This is a SYMPATHETIC block
Brachial plexus block helps with pain in which areas? What type of pain?
Breast- useful post mastectomy
Good for FOCAL pain
Somatic block
Gasserian ganglion block helps with pain in what areas?
Trigeminal nerve
Method of LAST resort- lowest risk for adverse side effects
This is for FOCAL pain
Somatic block
What block may be first line medical management?
Celiac plexus block (sympathetic block)
for upper abdominal/pancreatic cancer
Side effects: hypotension/orthostasis, diarrhea
Lumbar subarachnoid block indication
Unilateral leg pain
Phenol saddle block indication
Pelvic pain
Pudendal nerve block indication
Chronic pelvic pain (interstitial cystitis)
Intercostal nerve block indication
Chest wall pain, metastatic breast cancer, rib lesions
Medial branch block is in what location? Indication?
Block of medial branch of primary dorsal ramus which innervates facet joints of spine
Useful for intractable pain (malignant vertebral compression fractures)
Prognosis required for epidural pain pump? Complications?
Must have life expectancy is DAYS TO WEEKS
Uses higher dose of medications than intrathecal pumps (more complications)
Higher risk of CATHETER FIBROSIS
Requires frequent pump refills
Prognosis requires for intrathecal pain pump?
Must have life expectancy weeks to months
Appropriate for patients on >100 MEQ with refractory pain
Lower risk of catheter fibrosis and uses LOWER doses of medications (limits side effects)
Possible side effects of medications used in Neuraxial Blocks?
Side Effects
- Morphine: Catheter tip granuloma
- RESPIRATORY DEPRESSION (rare)
- Bupivicaine: urinary retention, paresthesia, LE weakness, gait impairment, orthostatic hypotension (EMERGENCY!)
- Ziconotide: Psychosis
Possible complications of intrathecal pain pump placement? (6)
Spinal cord injury/nerve injury- EMERGENCY
CSF leak
Infections
Migration, fracture of catheters
“Pump dump” with release of large concentrations of analgesia
Formation of granulomas
Morphine conversion from IV to epidural to intrathecal
10 mg IV= 1 mg epidural= 0.1 mg intrathecal
Ratio from IV to IT is 1:100 (10 mg to 0.1 mg)
When to use a medial branch block rather than kyphoplasty?
Epidural disease
Neurologic damage related to vertebral fracture
Fracture with BONE FRAGMENT extension into spinal canal
Infection
Severe cardiopulmonary disease
Hyper-coagulable state
Timeline for pain improvement after XRT?
Pain relief typically in 2-4 weeks
St. John’s Wort- interference/SE? (3 interactions)
Interferes with metabolisms of opioids
Interacts with blood thinners
Increases risk of SS
Alpha lipoic acid- interference/SE?
Used for diabetic neuropathy and cancer prevention
Risk of HYPOGLYCEMIA and arrythmia
Chondroitin- interference/SE?
Used for joint pain
Interferes with metabolism of blood thinners and opioids
Turmeric- interference/SE? (5 major bad things)
Used as anti-inflammatory and fibromyalgia, OA
Causes GERD, iron deficiency, bleeding (slows clotting)
Can cause hypoglycemia
Interferes with oncology TX and anticoagulants
Ginger- interference/SE? (4)
Increases blood glucose
Increases bleeding risk
Can affect heart at high doses
Interacts with coumadin
Devil’s Claw- interference/SE?
Affects BP
Increased PUD risk
Hypoglycemia
Interacts with coumadin
Diarrhea, headache, anorexia, nausea
Black licorice- interference/SE?
Causes hyper aldosteronism (low K, high Na), hypertension, swelling, fatigue, nausea, muscle cramps
