RT Book, Section A1 Shah, Rinoo V. A2 Diwan, Sudhir A2 Staats, Peter S. SR Print(0) ID 1107197944 T1 Epidural Lysis of Adhesions T2 Atlas of Pain Medicine Procedures YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738767 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1107197944 RD 2024/03/29 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.