Pain block (guided)

Consent Information - Patient Copy
Pain Block (Guided)
The medication is inserted and the needle is taken 1. What is a Pain Block?
A Pain Block is an injection that gives` temporary relief from pain. It may also help in locating the source of If you are having multiple levels of the spine treated At the end, a dressing will be applied to the puncture A mixture of a local anaesthetic and steroid medication may be injected. Steroids are anti- Pain relief from the injection can be long lasting or 5. After the procedure
Take care when you first stand, as temporary leg Pain Blocks performed in medical imaging are done with guidance from imaging machines such as CT. For Staff will discuss with you what level of activity is more information on CT and the risks involved in it’s use, please read the CT Patient Information Sheet (if
you do not have this information sheet please ask for one). 6. What are the risks of this specific
procedure?
2. Will there be any discomfort, is any
The risks and complications with this procedure can anaesthetic needed?
include but are not limited to the following. This procedure will require the injection of local Common risks and complications include:
anaesthetic. It is used to prevent or relieve pain, but • Bleeding or bruising may occur. This is more common if you take Aspirin, Warfarin, Clopidogrel (Plavix and Iscover) or Dipyridamole (Persantin and Asasantin). 3. Preparation for the procedure
• Backache due to the muscle being aggravated by The medical imaging department will give you the insertion of the needle. It is usually mild and instructions on how to prepare for your procedure. • Please tell the staff if you are or suspect you might • Sciatica pain due to the ‘pressure effect’ from the injection volume on the nerve. It is usually mild • If you take Aspirin, Warfarin, Clopidogrel (Plavix and Iscover) or Dipyridamole (Persantin and • Minor pain, bruising and/or infection from injection Asasantin) or any other drug that is used to thin site. This may require treatment with antibiotics. your blood ask your doctor/health practitioner if you should stop taking it before the procedure as it may • Failure of local anaesthetic which may require a further injection of anaesthetic or a different method of anaesthesia may be used. • List or bring all your prescribed drugs, those drugs • Nerve damage is usually temporary, and should you buy over the counter, herbal remedies and Less common risks and complications include:
Do not drink any alcohol and stop recreational drugs 24 hours before the procedure. If you have a • Infection, requiring antibiotics and further • Damage to surrounding structures such as blood vessels, organs and muscles, requiring further 4. During the procedure
Pictures will be taken of the injection site. • An allergy to injected drugs, requiring further The doctor will inject local anaesthetic. Using CT imaging as a guide the doctor will insert the • Adverse effects from the injected steroids needle. Pictures are repeated every time the needle is including insomnia, nightmares and nervousness. You must remain as still as possible. At times, you • The procedure may not be possible due to You must let the doctor know if you have any sharp Rare risks and complications include:
• Injury to the spinal cord. This may require Iodinated Contrast may be injected to check the • Permanent nerve damage with possible paralysis. Page 1 of 2 Continues over page ►►► Consent Information - Patient Copy
Pain Block (Guided)
• An increased lifetime cancer risk due to the • Seizures and/or cardiac arrest due to local • Death as a result of this procedure is very rare. 7. What are the safety issues when you
leave the hospital?
Take care not to injure or bump the area that has been numbed with the local anaesthetic as you will not be able to feel it. Go to your nearest A&E (Accident and Emergency) department or GP if you become unwell or have; • pain, unrelieved by simple pain killers • unexplained numbness in your legs • continuous bleeding or swelling at the puncture • redness or inflammation at the puncture site • fever • other warning signs the doctor may have asked Notes to talk to my doctor/ health
practitioner about:

  • PAIN BLOCK (GUIDED) - CONSENT FORM
  • PATIENT INFORMATION SHEET - CT - COMPUTED TOMOGRAPHY
  • Source: http://www.qemedicalimaging.com.au/upl/website/patient-information/PainBlockGuided.pdf

    Microsoft word - safety_medicalform.doc

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