Safety in Interventional Pain Practice: Step-by-Step Protocols and Ethical Guidelines

Safety in Interventional Pain Practice: Step-by-Step Protocols and Ethical Guidelines

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  SAFETY IN INTERVENTIONAL PAINPRACTICE Dr. Gautam Das www.Daradia.com
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  RISKS OF INTERVENTIONALPROCEDURES:  Risks related to invasiveness of the procedure.  Risks related to drugs used in the procedure.  Risks involved with the instruments used in the procedure.  Risks due to anatomical location of the procedure  Risks related to any invasive procedure.
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  SAFETY STEPS IN INTERVENTIONALPROCEDURES
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  SAFETY STEP-I: SELECTIONOF RIGHT PATIENT FOR RIGHT PROCEDURE  Will end in failure if not right patient is chosen for right procedure.  Patient will be facing undue risks of a interventional procedure.  No interventions should be done unless all criteria for selecting a patient for a procedure is fulfilled.
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  SAFETY STEP-II: INVESTIGATIONSTO RULE OUT CONTRAINDICATIONS  TLC, DLC rule out infection.  Blood sugar level to rule out uncontrolled diabetes.  Coagulation profile to rule out coagulopathy.
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  SAFETY STEP-III: EXPLANATIONOF PROCEDURE, RISKS & BENEFITS TO THE PATIENT AND THEIR RELATIVES  Informed consent .  Preliminary psychological evaluation .  Explanation risks and benefits.
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  SAFETY STEP-IV: PRE-PROCEDURE PREPARATION Nil per mouth for few hours,  Intravenous line should be secured,  Skin test of antibiotics should be done when required,  Patients vital parameters measured,  General anesthesia should be avoided.
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  SAFETY STEP-V: THOROUGH ANATOMICALKNOWLEDGE  It is essential to have thorough anatomical knowledge of that region where procedure is done.  We can see only bone on fluoroscopy, not the other structures.  We must know about other structures which are not seen in relation with bones.
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  SAFETY STEP-VI: KNOWLEDGEOF ALL POSSIBLE COMPLICATIONS  We must know all possible complications,  How to avoid those complications.  Identification of complications as early as possible, if it happens.  Management of those complications.
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  SAFETY STEP-VII: POST-PROCEDURE ADVICE At the time of discharge patients must be explained about all the danger signals when they must report clinic.  Long term complications must also be explained nicely.
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  SAFETY STEP-VIII: SAFETYOF DOCTORS  Possible radiation hazards and how to minimize.  Legal hazards regarding new procedures;  Efficacy & complications of the procedure must be explained to the patients;  Current level of evidence and recommendation of that procedure.
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  CASE-I  A 60years old female patient of vertebral compression fracture of 4 weeks duration.  But diagnosed only recently.  Pain already reduced from 9/10 to 2/10 with conservative management.  She can sit comfortably with mild pain.  Patient is very much worried because of presence of fracture.  She is ready for any procedure if it is required to prevent future complications.
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  CASE-II  A 30years old male patient suffering from leg pain on right side which is going down up to great toe.  MRI shows L4-5 disc prolapse with L5 nerve root compression right side.  Pain reduced to 1/10 from 7/10 over 6 weeks with conservative management.  No neurodeficits were present from the beginning.  Patient is very much worried and is ready for any procedure if it is required to prevent future complications.
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  ETHICS IN INTERVENTIONALPRACTICE:  Don’t do procedure unless it is essential.  Always try conservative management wherever there is such scope.  Never do any procedure in asymptomatic patient whatever is image findings.  Don’t consider more invasive procedure without trying less invasive procedure.  Never do any procedure primarily for 1. Money 2. Publication 3. Learning or practicing a procedure
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