TY  - CHAP
M1  - Book, Section
TI  - Epidural Lysis of Adhesions
A1  - Shah, Rinoo V.
A2  - Diwan, Sudhir
A2  - Staats, Peter S.
Y1  - 2015
N1  - 
T2  - Atlas of Pain Medicine Procedures
AB  - Epidural  lysis  of  adhesions  refers  to  a  percutaneous  spinal  procedure  for  pain  relief  (Racz  procedure).  Pain  may  occur  due  to  epidural  inflammation,  nerve  root  compression,  venous  engorgement,  and  scar  tissue.  Under  contrast-enhanced  fluoroscopy,  a  steerable  radiopaque  catheter  is  used  to  deliver  several  drugs  to  the  target  “pain  generator”;  these  include  local  anesthetics,  hyaluronidase,  hypertonic  saline,  and  steroids.  Contrast  epidurography  identifies  correct  placement  and  permits  early  detection  of  subarachnoid,  subdural,  or  intravascular  placement.  Local  anesthetics  reduce  intraoperative  and  postprocedural  pain.  An  enzymatic  agent  (hyaluronidase)  or  mechanical  motions  (moving  the  catheter  back  and  forth)  are  used  to  “loosen”  peridural  scar  tissue.  Hypertonic  saline  (10%)  is  used  to  reduce  intraneural  edema.  Steroids  modulate  inflammation.  This  procedure  was  initially  developed  for  patients  with  symptomatic  epidural  scarring,  ie,  post-laminectomy  syndrome.  Published  studies  report  safe  and  efficacious  outcomes  following  epidural  lysis  of  adhesions  for  several  spinal  pain  etiologies:  failed  back  surgery  syndrome,  post-laminectomy  syndrome,  spinal  stenosis,  lumbar  radiculopathy,  and  cervicalgia.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1107197944
ER  -