frequent procedures
 

OTHER INFUSION THERAPIES
There are other infusion therapies that are frequently used in the management of patient's with chronic pain:

A. PERCUTANEOUS EPIDURAL INFUSION THERAPY.
Percutaneous epidural infusion therapies have been used frequently in patient's with reflex sympathetic dystrophy of the lower extremities, in which an epidural catheter is usually placed in the lumbar epidural space or the thoracolumbar epidural space and the epidural catheter is tunneled under the skin from the site of placement in the intralaminar region to the area of the lateral to the abdominal wall and then secured and connected to an infusion pump, which the patient can wear as a sling or a bag that delivers the medication into the epidural space at programmed intervals, usually as boluses of infusion to control pain. A patient with reflex sympathetic dystrophy or complex regional pain syndrome can benefit from this treatment. The treatment itself is usually short-term and may last anywhere between seven days to a two-week period on the average before needing reevaluation.

Complications - Complications include infection and no sedation is required during the placement of this epidural catheter and internally can be done under local anesthesia. The procedure is usually tolerated by patients.

B. PERCUTANEOUS LUMBAR SYMPATHETIC INFUSION THERAPY.
Percutaneous lumbar sympathetic infusion therapy is done in patients with sympathetic maintained pain of the lower extremities, in which the lumbar sympathetic chain is localized by a cannula under fluoroscopic guidance and then a radio-opaque catheter is inserted into the lumbar sympathetic chain region along the lumbar paravertebral region where the sympathetic chain lies and is confirmed by both dye injection and fluoroscopic. This is then secured and the catheter is tunneled under the skin of the patient and then immerged and is again secured and is eventually connected to an infusion pump that delivers the medication from the reservoir that the patient may be carrying in order to achieve constant blockage of the sympathetic chain on the ipsilateral side. This can be very beneficial when patients have demonstrated short-term improvements following single shots of lumbar sympathetic blocks with local anesthetics.

Contraindications - This is the same as for patients with lumbar sympathetic blocks and epidural infusion therapy.
Complications - Infection as well as migration of the tip of the catheter since the catheter will have to pass through the highly muscular region of the lumbar paravertebral back muscles that are likely to result in displacement and migration of the implanted infusion catheter.

Sedation - The procedure is usually not done under sedation, though light sedation may be necessary in some circumstances.

C. LIDOCAINE INFUSION THERAPY.
Lidocaine infusion therapy is used also to treat patients with chronic pain as a result of multiple causes that have not responded well to conventional oral medications or blocks, but have responded well to a trial of Lidocaine infusion therapy. These treatments are usually given at intervals ranging from weekly intervals to biweekly intervals and may prove to provide the patients involved with the best quality of life as opposed to any other trial treatment they may have had also in the past.

Contraindications - Patients with an unstable history of arrhythmia are a related contraindication and treatment should be done with intensive monitoring of the cardiac status of these patients.

Complications - Complications include cardiac arrhythmias and cardiovascular collapse, both of which may occur with a sudden release and poor control of the infusion rate in the individual patient. Monitoring of the EKG continuously during the procedure is recommended.

Sedation - Sedation is not required during this procedure.
 

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