Caudal epidural steroid injection with Racz catheter Fluoroscopy IV sedation

PROCEDURES:

1.  Caudal epidural steroid injection with Racz catheter.

2.  Fluoroscopy.

3.  IV sedation.

ANESTHESIA:  Local and IV sedation.

PREOPERATIVE DIAGNOSIS:  Lumbosacral radicular pain.

POSTOPERATIVE DIAGNOSIS:  Lumbosacral radicular pain.

INDICATIONS:  Pain, refractory to conventional therapy.

ESTIMATED BLOOD LOSS:  Minimal.

COMPLICATIONS:  None.

DESCRIPTION OF THE PROCEDURE:  The patient was identified in the holding room.  Written informed consent was obtained, including the discussion of the risk, benefits, and alternatives to the procedure.  An IV was placed and the patient was taken to the fluoroscopic suite and positioned prone on the procedure table.  IV access was confirmed.  Monitor is applied.  Time-out performed and mild IV sedation begun by the sedation nurse under direct MD supervision.  The patient’s lumbosacral area was prepped and draped in sterile fashion with Betadine x3.  Utilizing a lateral fluoroscopy, the sacral hiatus was identified and 3 cc of 1% lidocaine was used to anesthetize the overlying subcutaneous tissue via a 25-gauge 1.5 inch needle.

Next, an 18-gauge Tuohy needle was advanced under intermittent lateral fluoroscopic guidance towards the sacral hiatus and into the epidural space.  After negative aspiration to blood or CSF, a Racz catheter was inserted through the Tuohy needle into the epidural space with lateral fluoroscopy confirming good spread into the epidural space.

Next, AP views were utilized and a live fluoroscopy was utilized to advance the Racz catheter upto the L5 vertebral body level.  After negative aspiration for blood or CSF, 3 cc of Omnipaque radiocontrast solution was injected into the epidural space demonstrating very good spread within the epidural space and along the S1 and S2 nerve roots.

Next, 5 cc of solution containing 3 cc of 0.25% preservative free bupivacaine and 80 mg of Kenaolog was then cranially injected following negative aspiration for blood or CSF into the epidural space.  All needles were removed, intact, and hemostasis was appreciated.  A meaningful verbal contact was maintained with the patient throughout the entire procedure.  The patient was then allowed to recover on a monitor setting for 30 minutes prior to discharge home in stable condition and no complications were noted