HJH,M

DR TIM GRICEINFORMATION SHEET AND CONSENT FOR PULSED RADIOFREQUENCY ANTERIOR CUTANEOUS NERVES OF THE ABDOMEN

The Anatomy of the Abdominal Nerves

The nerves that supply the abdomen arise from the thoracic spine and travel around to the abdomen through the skin and muscle layer. These nerves supply both the muscle and skin with sensation (touch and pain) as well as cause muscle contraction (power) to the area. These nerves are called the Anterior Cutaneous Nerves of the Abdomen. When damaged or irritated these nerves can send out pain signals that are felt in the brain. Often these pain signals are misinterpreted as coming from inside the abdomen from such organs as the bowel, gallbladder or stomach. They can send out pain signals after open or laparoscopic surgery, direct injury to the muscle or even spontaneously with any obvious injury.

Treatment of Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) using Pulsed Radiofrequency

The same anterior cutaneous nerves of the abdomen supply the muscles (rectus sheath) of the abdomen The diagnosis has already been made from a combination of history, clinical examination and distribution of the pain as well as injections with local anaesthetic and possibly steroid to these sites

Once the diagnosis has been confirmed and the pain returns there are 2 options

This serves two purposes

1. Repeat the injections if the patient has had long term benefit from the injections; 2. Progress to Pulsed Radiofrequency to these painful sites

While it is not possible to predict or guarantee the effectiveness of any treatment, this procedure may give good long-term relief, partial relief to the primary cause of pain.

Possible results of the procedure

It may treat the pain and the pain does not return It may treat the pain for a short period of time (weeks to months) and then the pain returns

either less or the same as before. In this case a repeat injection or pulsed radiofrequency may be considered.

There may be no effect on the pain

How is the Procedure performed?

The procedure will be provided as a day patient procedure at a Private Hospital. You will be advised of the time and place when the appointment is sent to you.

You will need to be fasted for at least six hours before the procedure. This usually means nothing to eat from midnight the night before a morning procedure, or if your procedure is in the afternoon you may have a light breakfast before 7am.

You should take all your usual painkillers and other medication unless specifically advised otherwise. People on medication for diabetes should discuss what to do regarding insulin and oral hypoglycaemic drugs prior to the procedure

If you are on any blood thinning agents such as warfarin, clopidogrel (Plavix) or Asasantin please let the pain specialist know well in advance as special arrangements will have to be made. This may include stopping these medications up to ten days before the procedure otherwise the injection may have to be rescheduled. You may also need to change onto other blood thinning injections for the period leading up to the procedure.

Please bring a list of your medications and mention any allergies.

You will need someone to drive you home after the procedure and care for you for the next twenty four hours.

This procedure is usually performed under sedation by the anaesthetist present, via an IV cannula in the hand, as well as oxygen provided via nasal prongs along with the standard anaesthetic monitoring

How is the Pulsed Radiofrequency to the Anterior Cutaneous Nerves performed?

It is very similar the Rectus Sheath block and is usually only used as a treatment option after injections into the area has already relieved the pain in the past.

The tender areas are identified using gentle palpation. The area is sterilised with Alcoholic Chlorhexadine. The focal points are injected with subcutaneous local anaesthetic and then the PRF needles a positioned in the painful areas.

The needle is heated to 45C for 9 minutes. The treatment is often repeated at a number of sites in the abdomen. This is to numb the nerve supply to the muscle without affecting the muscle function. This will only bring relief if these nerves are the cause of the pain

COMPLICATIONS

This procedure is usually safe and uneventful. However, as with any procedure there is always a small degree of risk.

Common Complications Continuing pain / no benefit

Minor bleeding in the area injected Bruising in the area injected Temporary weakness or numbness from the local anaesthetic Brief increased pain that may fluctuate in intensity

More Serious Side Effects 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 Bruising around the area from needle trauma Aspiration during sedation Eye injury Serious anaesthetic / procedural complications and very rarely death Increased lifetime risk of cancer due to X-rays exposure Very rare risk of surgery due too organ perforation from the procedure

Please 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, or Have any other concerns,

Please contact your General Practitioner, Queensland Pain Clinic, or the Emergency Department of your local hospital.Dr Tim Grice Specialist Pain Medicine Physician

Queensland Pain Doctor Suite 4, Level 4. 123 Nerang St Southport, QLD 4215

Phone: 07 5532 0468 Fax: 07 5528 3850 Email: admin@qpdr.com.au

What happens after the procedure?

You will be moved to the recovery area and will be monitored until you have recovered from the sedation and procedure.

You will then move to the second stage of the recovery process before being discharged into the care of a support person.

Wherever possible, the pain specialist performing the procedure will review you before you have been discharged.

You will also receive a follow-up phone call over the next few working days to discuss any benefits or side effects and arrange your next appointment with the pain specialist.

This document provides information on who to contact should you have any questions or complications.

Should the pain specialist be unavailable to immediately review and/or treat a complication, then the second point of contact would normally be your own GP.

If they are unavailability then you should present to the nearest emergency department if you have any major complications or concerns.

Some patients are unsuitable for this treatment and they typically include patients with Cardiac pacemakers and also spinal cord stimulators, as the radiofrequency signals may interfere with their functioning.

Please 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, or Have any other concerns,

please contact your General Practitioner, Queensland Pain Doctor, or the Emergency Department of your local hospital.

Dr Tim GriceSpecialist Pain Medicine PhysicianQueensland Pain DoctorSuite 4, Level 4123 Nerang StSouthport, QLD 4215Phone: 07 5532 0468Fax: 07 5528 3850Email: admin@qpdr.com.au

CONSENT

I have had time to read and I understand the information and instructions provided to me regarding Pulsed Radiofrequency to the Anterior Cutaneous Nerves of the Abdomen and post-procedural care. Common Complications:- Continuing pain / no benefit, Minor bleeding in the area injected, Bruising in the area injected, 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, Bruising around the area from needle trauma, Aspiration during sedation, Eye injury while lying prone (face down), Serious anaesthetic / procedural complications and very rarely death, Increased lifetime risk of cancer due to X-rays exposure, Very rare risk of surgery due organ perforation from the procedure

I 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 not applicable) in the Pain Specialist rooms / Operating Theatre (delete one option)

Patient Name: ___________________________________ Date: _________

Patient Signature: ________________________________

Doctor Name: ___________________________________

Doctor Signature: ________________________________

CONTACT DETAILS

Dr 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@qpdr.com.au