Pain Clinic Emergencies

Abstract

A B S T R A C TThe increasing recognition of the need to treat chronic pain has led to an increase in the number of interventional procedures performed on an outpatient basis, and consequently, a rise in the number of complications as well. Safe interventional pain management requires Pain specialists have a comprehensive understanding of how to perform a procedure as well as how to manage any acute complications. Though simplistic, an emphasis on prevention is the solution to avoiding a complication. This involves meticulous planning of the injection technique based on the relevant anatomy, thoughtful selection of doses and concentrations of medications, careful injection of the medications, and attentive monitoring of the patient. When prevention is not enough, preparation can be life-saving. Resuscitation equipment should be readily accessible, and physicians should be prepared to institute Advanced Cardiac Life Support protocols. Immediate recognition of the signs and symptoms associated with a vasovagal reaction, hypotension, hypertension, systemic local anesthetic toxicity, high spinal, pneumothorax, and anaphylaxis is paramount, as prompt treatment offers the best chance for a successful outcome.

Interventional Management for Cancer Pain

“…In most cases, patients recover after conservative management such as cessation of the procedure, lying supine or in a Trendelenburg position, and administration of intravenous fluid and oxygen [42].…”

Intravenous Conscious Sedation for Routine Fluoroscopically Guided Lumbar Interventions

“…First, it has been shown that patients with chronic pain conditions are more anxious at baseline and therefore may be at higher risk for procedural‐related anxiety than the general population [3,4]. Second, some complications specifically relating to anxiety, namely vasovagal reactions and intraprocedural hypertension, may be prevented through the use of anxiolytic medications [5‐7]. Third, studies have shown that certain patients prefer sedation for interventional pain procedures, especially when the option is discussed in detail prior to the procedure [8,9].…”

“…Specific complications relating to interventional pain management procedures may be related to periprocedural anxiety. A vasovagal reaction, which is a complex neurovascular reflex mediated by the autonomic nervous system, is the most frequent adverse event reported from interventional pain management procedures [5,6]. Stress, anxiety, fear, or pain associated with needle placement are the most common triggers, and preliminary warning signs include nausea, vomiting, diaphoresis, pallor, lightheadedness, disorientation, bradycardia, and generalized weakness.…”

“…Stress, anxiety, fear, or pain associated with needle placement are the most common triggers, and preliminary warning signs include nausea, vomiting, diaphoresis, pallor, lightheadedness, disorientation, bradycardia, and generalized weakness. Caution should be exercised in patients who report a history of these types of symptoms with vaccinations and phlebotomy [5]. A retrospective review by Kennedy et al [7] that attempted to identify patients at highest risk for vasovagal reactions with interventional pain management procedures found that high‐risk patients are twice as likely to be male, 2.4 times more likely to be younger than 65 years, and have lower preprocedural pain scores [7].…”

“…Another complication that is potentially related to anxiety is periprocedural hypertension. Anxiety, fear, stress, or a history of hypertension increases the risk, and judicious use of an anxiolytic or opioid may reduce these symptoms and blood pressure [5].…”