Dr Tim GriceHJH,M

DR TIM GRICE

INFORMATION SHEET AND CONSENT FOR PULSED RADIOFREQUENCY TO FACIAL NERVE

FACIAL NERVE ANATOMY

The Facial Nerve supplies the face with sensation to some of the face as well as the muscles the control facial expression. It also supplies special sensation to the tongue. Any damage to the nerve can cause disturbance in an of these areas supplied by the nerve in the fact. There is one nerve for each side of the face so any injury is usually isolated to one side of the face

INJECTION TO FACIAL NERVE

There are occasions where the injection of local anaesthetic with or without steroid are indicated to the facial nerve. If the nerve is thought to be the source of facial pain, then the nerve may well be injected with local anaesthetic to confirm its involvement.

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Dr Tim GriceINDICATORS FOR PRF OF THE FACIAL NERVE

Facial Nerve Pain Positive injection with local anaesthetic with or without steroid to confirm that the facial

nerve is the source of the pain

PULSED RADIOFREQUENCY TO THE FACIAL NERVE (PRF)

PRF to the FACIAL NERVE is used to try and relieve pain in the face. It will not treat numbness or weakness. It is specifically designed to block the pain fibres contained within the Facial Nerve from sending pain signals to the brain.

Patients have usually had an injection with local anaesthetic often also containing steroid to the area as the test to ensure that the facial nerve is the cause of the pain. The injection is performed under sterile conditions and can have a number of complications including;; No benefit, Increased pain, Injury to the Facial Nerve, Injury to the Parotid Gland, Infection, Facial weakness including drooling, Disturbance t the sensation of the tongue

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Dr Tim Grice

WHEN BOOKING THE PROCEDURE

On the day of booking your procedure, please advise staff if you are – Taking blood thinners (especially warfarin and clopidogrel) Diabetic Pregnant, or any chance of being pregnant Allergic to:

o Shellfisho Steroids

o Local anaestheticso Iodine

o Betadineo Chlorhexidine

Unwell or have an infection

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Dr Tim Grice

DAY OF THE PROCEDURE

DO NOT eat or drink (for 6 hours before your procedure), TAKE your usual medications with a small amount of water (apart from those mentioned

previously), and ARRANGE for someone to accompany you home.

DURING THE PROCEDURE

After arriving you will need to complete the necessary paperwork. Then – You will change into a hospital gown, A small drip will be inserted into one of your veins, You may be given a mild sedative, Your heart rate and blood pressure will be monitored throughout the procedure, You will lie face down on an x-ray table, then the skin over the area to be injectedwill be

cleaned with an antiseptic solution, A sterile barrier will be created, A local anaesthetic will be injected to numb the area, You will be asked to map out your pain distribution, An x-ray machine will be used to guide a small needle towards the nerve, You may experience some discomfort, however this usually subsides and can be treated

with icepacks and medication.

AFTER THE PROCEDURE

You will be monitored in a recovery area until you are ready to go home. This usually takes between 60 – 120 minutes.

You will be given a pain relief chart to fill out. SHOW this to your doctor at your next consultation.

Preferably, someone will take you home and stay with you for the next 24 hours.

Pain may return when the anaesthetic wears off. Some people experience an initial increase in pain and stiffness, which may continue for several days. If necessary you may apply an ice pack to the area for 20 minutes at a time, for 1-2 days following the procedure.

You may take simple pain-killers such as Paracetamol to ease any discomfort.

Remove any dressing the day after your procedure. Avoid a rapid increase in your activities. Gradually increase your daily activities as

tolerated. Discuss this with your doctor.

If steroids were injected, it may take several days for the benefits to be noticed. Additionally, you may feel flushed in the face and/or notice a change in your mood for a few days. Diabetic patients may notice a rise in blood sugar levels.

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Dr Tim Grice

If you have received sedation during your procedure, the effects may last up to 24 hours. Due to the effects, you may not remember some of the information given to you during the procedure. For the next 24 hours, you SHOULD NOT –

o Drive a vehicle, o Drink alcohol, o Operate machinery,

o Make important decisions, o Sign legal documents, or o Travel unaccompanied.

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 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 too injuries 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

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Dr Tim GriceQueensland 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

CONSENTI have had time to read and I understand the information and instructions provided to me regarding the Injection / Pulsed Radiofrequency (delete one option) to the Facial Nerve 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 too injuries 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 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 4215

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Dr Tim GricePhone: 07 5532 0468 Fax: 07 5528 3850 Email: admin@qpdr.com.au

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