Patient Information & Informed Consent For Lumbar Or Sacraltransforaminal Steroid Injection

PATIENT INFORMATION & INFORMED CONSENT FOR FACET JOINT STEROID INJECTION

Facet joints are small joints between each vertebra which make up the spinal column. If these joints become the source of persistent pain in the lower back and/or referred dull ache pain into the lower limbs, then a local anaesthetic with steroid injection administered into or near the joint capsules of the selected joint can relieve the pain. This procedure is aimed at relieving back pain due to facet joint irritation or arthritis. This procedure is not aimed at relieving leg pain; however, you may experience some relief when pain is referred from these joints. This is a very precise procedure and if you have multiple sources of pain then the injections will not relieve the multiple sources of pain, only that which it is targeted at. You will need to exercise to strengthen the core muscles to prevent further recurrence of pain as the injection does not cure joint arthritis but is instead a means to break through the pain cycle.

Procedure: During the procedure, you will lie face down on the X-ray table with a pillow supporting your abdomen. You will be completely awake. Before the procedure commences, antiseptic will be applied to your lower back, and a sterile drape will be applied around the area of injection site. Just prior to the insertion of the needle, you will be told that it may sting a little. The needle is then directed through the back muscles towards the target point of the joint while under X-ray control. As the needle passes through muscle you may experience some discomfort. Most patients are usually able to tolerate this without a local anaesthetic, but if you experience any unmanageable discomfort, a local anaesthetic will be given during the needle insertion. Once the position of the tip of needle is confirmed, and it is deemed satisfactory, then a small amount of local anaesthetic and steroid is injected into the facet joint capsule or near the joint area (in the event of severe osteophytes). Usually, this procedure takes about 30 minutes, but it may take longer if you are unable to lie still, or if there is difficulty in visualising the needle in the correct position. You will need to remain in hospital for about 30 to 45 minutes after the procedure for the purpose of monitoring, and on rare occasions, people may require a crutch for support for a day.

There is a rare possibility that the procedure will need to be stopped before completion. This may occur if you are unable to lie still or, for any reason, the doctor deems it unsafe to proceed. In that instance, the doctor will discuss with you the options of postponing and rescheduling the procedure.

Please arrange for a friend or relative to drive you home after procedure.

Potential risks include (but are not limited to) infection, allergic reaction, hematoma, increased pain, dural puncture, spinal headache and/or nerve injury. You may expect temporary numbness and possible weakness in the lower limbs following the procedure due to the local anaesthetic. To reduce the risk of bleeding, please let us know if you are taking any anticoagulants (blood thinning agents) or have a tendency to bleed excessively.

If you understand the above and are happy with the information provided, please sign the consent blow authorising Dr Gajendra Singh to administer the procedure. Alternatively, do not hesitate to advise Dr Gajendra Singh if you have any queries or if you require further information before proceeding. In the event that you are not happy with the above information, you may decline to have the procedure.

Patient’s Signature Name of Patient

NHI Date Level(s) and side of treatment

MSM Pain Clinic, 150 Glasgow St. Wanganui Tel. 06 3457007, Fax 06 345 7011 Lumbar-Facet Joint Steroid Injection (Pre-injection check list) Dr Gajendra Singh

Patient Name ...... Date......

DOB...... NHI ......

Descriptions: Pain Map

Index pain – back/lower limb

Concurrent pain:...... Left

......

Four activites limited by index pain Right

1...... Right

2......

3......

4......

VAS: Worst Pain ever experienced /10 Back view

Worst ever index pain /10

Index pain today /10

Previous surgery lumbar spine Yes/No

Date/year of operation......

Assessor’s remarks:......

Any complication/side effects during or 30 minutes after injection

...... Medication Used: Kenacort-- Dexamethasone--- Local Anaesthetic--

Level: L5/S1 L4/5 L3/4 Bil Omonipaque---

Screen Time--- Radiation dose---

MSM Pain Clinic, 150 Glasgow St. Wanganui Tel. 06 3457007, Fax 06 345 7011