Interventional and Procedural Pain Management
Modalities
Interventional options include neuraxial techniques (epidural, intrathecal), peripheral nerve blocks, trigger point and joint injections, facet blocks with medial branch radiofrequency ablation, sympathetic blocks (stellate, lumbar, celiac plexus), spinal cord stimulation, intrathecal pumps, and vertebral augmentation.
Nursing preparation
Verify informed consent, allergies (local anesthetics, contrast, latex), pregnancy status for fluoroscopy, anticoagulant and antiplatelet status per protocol, NPO status, and IV access. Obtain baseline pain, function, and neurovascular assessment so post-procedure changes are meaningful. After the procedure monitor the site for bleeding, swelling, and infection, and assess sensation, motor function, and perfusion.
Complications to recognize
After any neuraxial procedure, new or worsening back pain, motor weakness, sensory change, or bowel/bladder dysfunction is an epidural hematoma until proven otherwise - escalate immediately. Post-dural puncture headache is positional and worse upright; it may need a blood patch. Local anesthetic systemic toxicity begins with perioral tingling, metallic taste, and tinnitus, progressing to seizures and arrhythmias; stop the injection, support the airway, and give 20% lipid emulsion per protocol. Steroid injections can raise glucose for days and cause flushing and insomnia - warn patients with diabetes. A working block masks pain, so teach patients to protect the numb limb from pressure and thermal injury.
Traps
A block that fails is a failed block, not proof the pain is psychological. Do not attribute new weakness to residual local anesthetic without evaluating. Do not assess neurovascular status only at rest.
Rule of thumb: any new neurologic deficit after a neuraxial or regional procedure is a same-minute escalation, not a routine reassessment.