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4140200-25273000hjh,mDR TIM GRICEINFORMATION SHEET and Consent for Facet Joint Pain Radio Frequency Neurotomy Treatment FACET JOINT PAIN (FJP) RADIOFREQUENCY NEUROTOMY (RFN) RFN is a procedure performed on the nerves that carry the pain signals from the facet joints. These joints may be subject to inflammation or arthritis particularly in the low back or neck where they can cause pain to the surrounding area. The aim of RFN is to interrupt the nerve supply to the painful joints by decreasing the pain signals being sent to your brain. This procedure does not treat the underlying arthritis in the joints. Also, this procedure does not give permanent relief from pain, as the nerves eventually recover and the pain can return. However, RFN may provide relief for 6-12 months. If the initial treatment is successful, this procedure can be repeated multiple times. Prior to this treatment, you will need to have had a positive response to Medial Branch Block (MBB) procedure performed to the same joints. The RFN procedure is performed in a similar way to the Medial Branch Block injections. However, this procedure – Targets nerves close to the joint,Takes longer to perform, Is more technically challenging, andAlso requires multiple levels of intervention.297180026606500FACET JOINT AND MEDIAL BRANCH NERVE THAT ARE TARGETED IN RFN INDICATORSNeck pain that may spread to the back of the head, neck and shoulder and can cause headaches;Pain in the back of the chest, by the ribs; orLow back pain that may spread to the buttocks. WHEN BOOKING THE PROCEDURE On the day of booking your procedure, please advise staff if you are – Taking blood thinners (especially warfarin and clopidogrel)- T Diabetic Pregnant, or any chance of being pregnantAllergic to:ShellfishSteroids Local anaestheticsIodineBetadineChlorhexidineUnwell or have an infection DAY OF THE PROCEDUREDO NOT eat or drink (for 6 hours before your procedure), TAKE your usual medications with a small amount of water (apart from those mentioned above), and ARRANGE for someone to accompany you home. DURING THE PROCEDUREAfter arriving you will need to complete the necessary paperwork. Then –You will change into a hospital gown, A small drip will be inserted into one of your veins,You may be offered mild/moderate sedationYour heart rate and blood pressure will be monitored throughout the procedure,You will lie face down on an x-ray table, then the skin over the area to be injected?will be cleaned with an antiseptic solution, A sterile barrier will be created, A local anaesthetic will be injected to numb the area,An x-ray machine will be used to guide a small needle towards the nerve, You may experience some discomfort, however this usually subsides and can be treated with icepacks and medication. AFTER THE PROCEDURE You will be monitored in a recovery area until you are ready to go home. This usually takes between 60 – 120 minutes.Preferably, someone will take you home and stay with you for the next 24 hours.Pain may return when the anaesthetic wears off. Some people experience an initial increase in pain and stiffness, which may continue for several days. If necessary you may apply an ice pack to the area for 20 minutes at a time, for 1-2 days following the procedure.You may take simple pain-killers, such as Paracetamol or opioids to ease any discomfort. Remove any dressing the day after your procedure.Avoid a rapid increase in your activities. Gradually increase your daily activities as tolerated. Discuss this with your doctor. If you have received sedation during your procedure, the effects may last up to 24 hours. Due to the effects, you may not remember some of the information given to you during the procedure. For the next 24 hours, you SHOULD NOT –Drive a vehicle, Drink alcohol, Operate machinery, Make important decisions, Sign legal documents, or Travel unaccompanied COMPLICATIONSThis procedure is usually safe and uneventful. However, as with any procedure there is always a small degree of mon ComplicationsContinuing pain / no benefitMinor bleeding in the area treatedBruising Numbness in the area treatedTemporary weakness or numbness from the local anaestheticBrief increased pain that may fluctuate in intensityMore Serious Side Effects Damage to surrounding structuresInfection Permanent nerve injuryAllergy to the anaesthetic drugs used as part of the procedureIncrease of any pre-existing medical condition such as cardiac conditions Burning sensation / Bruising around the area from the procedureAspiration during sedationEye injury while lying prone (face down)Serious anaesthetic / procedural complications and very rarely stroke or deathIncreased lifetime risk of cancer due to X-rays exposureVery rare risk of surgery due too injuries from the procedurePlease discuss with your doctor any other questions you may have about this procedure or this information sheet. If you agree to have the procedure, you will be asked to sign a consent form.If you notice –Any swelling from the site, Any bleeding from the site, orHave any other concernsPlease contact your General Practitioner, Queensland Pain Clinic, or the Emergency Department of your local hospital.Dr Tim Grice Specialist Pain Medicine PhysicianQueensland Pain Doctor Suite 4, Level 4. 123 Nerang St Southport, QLD 4215 Phone: 07 5532 0468 FFax: 07 5528 3850 Email: admin@.auCONSENTI have had time to read and I understand the information and instructions provided to me regarding the Facet Joint Radiofrequency Neurotomy procedure and the possible complications as well as the post-procedural mon Complications:- Continuing pain / no benefit, Minor bleeding in the area treated, Bruising in the area treated, Temporary weakness or numbness from the local anaesthetic, Brief increased pain that may fluctuate in intensityMore Serious Complications:- Damage to surrounding structures, Infection , Permanent nerve injury, Allergy to the anaesthetic drugs used as part of the procedure, Increase of any pre-existing medical condition such as cardiac conditions, Burning sensation / Bruising from the procedure, Aspiration during sedation, Eye injury while lying prone (face down), Serious anaesthetic / procedural complications and very rarely stroke or death, Increased lifetime risk of cancer due to X-rays exposure, Very rare risk of surgery due too injuries from the procedureI understand that I have the right at any stage to change my mind even after I have signed this document.I have had time to ask any questions and raise any concerns I have regarding this procedure and its risks with Dr Tim Grice.I understand that there are alternatives to this procedure including; no –treatment, medication and psychological support.I understand that if there were any immediate life threatening Incidents happen during the procedure that they will be treated as part of the procedure. I understand and agree that a sample of my blood can be taken and tested should a member of staff have exposure to my bodily fluids as part of the procedure. I believe that all my questions have been discussed and answered to my satisfactionI I understand that this is not a permanent treatment and the pain may return but repeat procedures may be a treatment option in the future.I consent to this procedure with / without sedation (delete one option)Patient Name: ___________________________________ Date: _________Patient Signature: ________________________________Doctor Name: ___________________________________Doctor Signature: ________________________________CONTACT DETAILSDr Tim Grice Specialist Pain Medicine Physician Queensland Pain DoctorSuite 4, Level 4, 123 Nerang St, Southport, QLD 4215Phone: 07 5532 0468 Fax: 07 5528 3850 Email: admin@.au ................
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