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Management of Perioperative Pain and Sedation for Interventional Radiology Procedures

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Pain Control in Ambulatory Surgery Centers

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Abstract

Interventional radiology is especially well positioned to succeed in an ambulatory surgery center. While minimally invasive procedures can often be performed with local analgesia and conscious sedation administered by the performing interventionalist, as procedures become increasingly complex or life-threatening, the use of regional nerve blocks, deep sedation, monitored anesthesia care (MAC), or general anesthesia (GA) can improve procedural success rates and patient-perceived experiences. Post-procedural discomfort is a common indication for admission. Effective pain management/anesthesia can be cost-effective by increasing same-day discharge rates. A thorough history and physical exam is necessary before any interventional procedure. High-risk populations include those patients with obesity, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), coronary artery disease, chronic renal failure, patients with drug addiction, and elderly/pediatric. Special pre-procedure considerations include risk of bleeding, contrast-induced nephropathy, adverse reactions to contrast, patient-positioning, breath-holding, vascular access site, and recovery planning. Additional considerations are based on the specific procedure planned and the imaging modality utilized.

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Abbreviations

GA:

 General anesthesia

IR:

 Interventional radiology

MAC:

 Monitored anesthesia care

PCA:

 Patient-controlled analgesia

RA:

 Regional anesthesia/nerve blocks

SA:

 Spinal anesthesia/paravertebral/epidurals

SIR:

 Society of Interventional Radiology

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Authors and Affiliations

  1. University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA

    Jonathan S. McDougal, Jonathan B. Kozinn & Brandt C. Wible

  2. Saint Luke’s Health System, Department of Radiology, Saint Luke’s Hospital, Kansas City, MO, USA

    Jonathan S. McDougal & Brandt C. Wible

  3. Kansas City University of Medicine and Biosciences, Kansas City, MO, USA

    Praveen N. Sankrithi

  4. Saint Luke’s Health System, Department of Anesthesiology, Saint Luke’s Hospital, Kansas City, MO, USA

    Jonathan B. Kozinn

Authors
  1. Jonathan S. McDougal
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  2. Praveen N. Sankrithi
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  3. Jonathan B. Kozinn
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  4. Brandt C. Wible
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Correspondence to Jonathan S. McDougal .

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Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, CT, USA

    Kanishka Rajput

  2. Department of Anesthesiology, Yale University, New Haven, CT, USA

    Nalini Vadivelu

  3. Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Science Center, Shreveport, LA, USA

    Alan David Kaye

  4. Department of Anesthesiology, Louisiana State University Health Science Center, Shreveport, LA, USA

    Rinoo Vasant Shah

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McDougal, J.S., Sankrithi, P.N., Kozinn, J.B., Wible, B.C. (2021). Management of Perioperative Pain and Sedation for Interventional Radiology Procedures. In: Rajput, K., Vadivelu, N., Kaye, A.D., Shah, R.V. (eds) Pain Control in Ambulatory Surgery Centers. Springer, Cham. https://doi.org/10.1007/978-3-030-55262-6_19

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