7901 SW 34th Ave
Amarillo, TX 79121
Victor M. Taylor, MD, DABA
Board Certfied Pain Management
Lysis of Adhesions
A lysis of adhesions or Racz’s procedure-was developed by Gabor Racz, M.D., At Texas Tech University Health Science Center School of Medicine Department of Anesthesiology Division of Pain Management. The lysis of adhesions is used in the treatment of patients with persistent pain along the spine or in the limbs or chest wall in a setting where the source of the pain is most likely due to a resistant adhesion within the epidural space.
A common setting for the lysis of adhesions is used is in a setting where patient is undergone surgery and symptoms returned.
The lysis of adhesions procedure can be effective for the majority of people even when other interventions have failed. Even a situation where epidural steroids, physical therapy and surgery have failed to make improvement the majority of patients can still benefit from the lysis of adhesions.
What the goal/purpose?
The goal with the lysis of adhesions is to use an epidural catheter along with specific medications to physically break up adhesions within the epidural space. Adhesions within the epidural space can lead to irritation of the nerve roots and surrounding structures.
What should I do to get ready for the procedure?
Stop taking any medication that thins the blood at least 5 days prior to the procedure. These medicines include Aspirin, and most over the counter pain medicines except Tylenol. Read the list of medications that must be stopped that was given to you at your office visit. Make sure it is ok with your prescribing doctor before you stop prescription blood thinners used for treatment of heart disease, peripheral vascular disease, irregular heartbeat or history of stroke. It is your responsibility to clear this with your doctor.
Continue to take your other medications. Do not stop blood pressure or diabetes medicines.
Do not eat or drink anything on the morning of your procedure. You may eat and drink afterward.
How is it done?
Patients lie face down on the top of a treatment table. The area to be injected is thoroughly prepared and draped in a sterile manner. As with all procedures vital signs will be measured during the procedure. X-ray guidance using a fluoroscopic x-ray machine is used.
After skin anesthesia is achieved with 1% lidocaine. A specially designed epidural needle is placed into the epidural space. A specially designed catheter, a little bit smaller than a pencil lead,. Is guided under fluoroscopic x-ray into the epidural space. Were points of resistance our management medication is injected to help break up adhesions. Once the catheter reaches its target or runs into an adhesion that cannot be breached the needle is removed and the catheter secured in place. This leads to phase II of the procedure.
During phase II of the procedure the patient rests in the postop recovery area under the supervision of the postop recovery nurse while 4-8 cc of hypertonic saline is infused into the epidural space. This takes approximately 1 hour. Once this face as complete the catheter was flushed with a sterile preservative-free saline and then it is removed.
What is injected?
Skin anesthesia is performed with lidocaine, a common local anesthetic. Once the catheter is in place a radiocontrast substance is used to make sure the catheter is in the right tissue plane. The therapeutic portion of the injection includes a local anesthetic, usually ropivacaine, Hyaluronidase enzyme, a steroid such as dexamethasone or methylprednisolone, saline, hypertonic saline..
Will it hurt?
Most people tolerate these procedures very well. There is some discomfort associated with numbing the skin and there may be pressure during the injection. Some patients require some sedation for the procedure others do not. The vast majority of patients tell us ‘that wasn’t so bad.” or “I can’t believe I was worried about that.” However some people do find it painful. As with all her procedures sedation is available.
The day of the procedure you may have a great deal of weakness. When this procedure is done in the neck/cervical spine weakness can occur in the arms or anywhere below the level where the procedure was performed. When this procedure is performed in the thoracic or chest region it can lead to weakness below the level where it was performed. When this procedures performed in the low back it can lead to weakness of the legs.
Some minor bruising in minor discomfort at the injection site are normal with these type of injections. The catheter is inserted just above the gluteal cleft, the areas most commonly referred to as the “crack”. Because minor bleeding can occur during the procedure this can run into the area of the gluteal cleft. Do not be concerned if the first time you use the toilet paper after this procedure there is some blood on it,
About 30% of patients feel worse temporarily after this procedure and this can last up to 6 weeks. This is usually due to the success of the procedure and the nerves “waking up” after breaking up adhesions. The hypertonic saline used in the procedure can also lead to nerve irritation that can last for several weeks.
It is of utmost importance to perform the neural flossing exercises after this procedure.
What is the chance of success?
Approximately 75-80 % of our patients get significant relief from this procedure. This is truly a remarkable outcome considering that this procedures only used in patients who have failed to improve with any other approach.
How often can the procedure be repeated?
A person gets very good relief, at least 50-80% reduction in pain in the area that last for a reasonable period of time the injections can be repeated up to 2-3 times per year.
What can I do to maximize my chance of success?
Performing the neural flossing exercises twice a day every day for the first 6 weeks after the procedure will maximize her outcome. Continuing the neural flossing exercises going forward throughout your life will be a worthwhile investment in time and effort
Why do I have a blue towel stocking my clothing?
We place a sterile towel over the injections sites to absorb in mild bleeding and protect your cloths.
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