smoh/medical-transcriptions huggingface dataset:
Sacral Alar Notch Injection  ( Pain Management)
Description:  Right sacral alar notch and sacroiliac joint/posterior rami injections with/without fluoroscopy.

PROCEDURE:,  Right sacral alar notch and sacroiliac joint/posterior rami injections with fluoroscopy.,ANESTHESIA:,  Local sedation.,VITAL SIGNS: , See nurse's notes.,COMPLICATIONS:  ,None.,DETAILS OF PROCEDURE: , INT was placed.  The patient was in the operating room with intravenous line in place and intravenous sedation was given.  The patient was in the prone position.  The back was prepped with Betadine.  Under fluoroscopy, the right sacral alar notch was identified and after placement of a 22-gauge, 3-1/2 inch spinal needle in to the notch, negative aspiration was performed and 5 cc of 0.5% Marcaine plus 20 mg of Depo-Medrol was injected.  The needle was then placed in to the right sacroiliac joint (distal third) and the same local anesthetic mixture was injected.  This was repeated for the right sacral alar notch and the right sacroiliac joint (distal third).  The needle was withdrawn.  The above was repeated for the posterior primary rami branch at S2 and S3 by stimulating along the superior lateral wall of the foramen; then followed by steroid injection and coagulation as above.,There were no complications.  Needles removed.  Band-aids were applied over the puncture sites.  The patient was discharged to operating room recovery in stable condition.
Neuroplasty  ( Pain Management)
Description:  Left L4-L5 transforaminal neuroplasty with nerve root decompression and lysis of adhesions followed by epidural steroid injection.

PREOPERATIVE DIAGNOSES:,  ,1.  Recurrent intractable low back and left lower extremity pain with history of L4-L5 discectomy.,2.  Epidural fibrosis with nerve root entrapment.,POSTOPERATIVE DIAGNOSES:,  ,1.  Recurrent intractable low back and left lower extremity pain with history of L4-L5 discectomy.,2.  Epidural fibrosis with nerve root entrapment.,OPERATION PERFORMED:,  Left L4-L5 transforaminal neuroplasty with nerve root decompression and lysis of adhesions followed by epidural steroid injection.,ANESTHESIA:,  Local/IV sedation.,COMPLICATIONS:,  None.,SUMMARY:  ,The patient in the operating room, status post transforaminal epidurogram (see operative note for further details).  Using AP and lateral fluoroscopic views to confirm the needle location the superior most being in the left L4 neural foramen and the inferior most in the left L5 neural foramen, 375 units of Wydase was injected through each needle.  After two minutes, 3.5 cc of 0.5% Marcaine and 80 mg of Depo-Medrol was injected through each needle.  These needles were removed and the patient was discharged in stable condition.
Plantar Fascia Injection  ( Pain Management)
Description:  Plantar Fascia Injection

PROCEDURE:,:  Informed consent was obtained from the patient.  Special mention was made of the possibility of infection and necrosis of the heel pad.  The patient was placed in the supine position.  The tender area in the medial aspect of the heel was identified by palpation.  After proper preparation with antiseptic solution of the skin, a syringe containing 2 mL of 1% lidocaine was attached to 1.5" 27 gauge needle.  The needle was carefully advanced through the carefully identified point at a right angle to the skin, directly towards the central and medial aspect of the calcaneus.  The needle was advanced very slowly until the needle impinged on the bone, and then was withdrawn slowly.  The contents of the syringe were then gently injected.  Subsequently, the needle was left in place and a syringe containing 2 mL of 0.25% Marcaine and 1 mL of Depo-Medrol was attached to the needle and injected after aspiration at this site.  Subsequently the needle was removed.  Pressure was applied at the site of insertion and once it was made sure there was no bleeding taking place, a small bandage was applied.,POST PROCEDURE INSTRUCTIONS:, The patient has been asked to report to us any redness, swelling, inflammation, or fevers.  The patient has been asked to restrict the use of the * extremity for the next 24 hours.
Lumbar Epidural Steroid Injection - 2  ( Pain Management)
Description:  Lumbar epidural steroid injection, L5-S1.  Low back pain.

PREOPERATIVE DIAGNOSIS: , Low back pain.,POSTOPERATIVE DIAGNOSIS: , Low back pain.,PROCEDURE: , Lumbar epidural steroid injection, L5-S1.,ANESTHESIA: , Local.,SPECIAL EQUIPMENT: , Fluoroscopic unit.,DETAILS OF PROCEDURE: , The patient was taken to the Radiology Suite and was placed in the prone position where the entire back region was scrubbed, prepped, and draped in a sterile fashion with Betadine solution.  The lumbar area was then draped with sterile towels and sterile drapes.  The surgeon was gloved with sterile gloves and mask in order to create a sterile environment for the epidural injection.  The fluoroscopy x-ray unit was then brought into the sterile field for a PA x-ray visualization of the spine.  A Steinmann pin was then placed across the spine to localize the level of the planned injection.  Local infiltration using 0.5% preservative-free Xylocaine via a 25-gauge needle was then placed into the dermis and subcutaneous tissue.  A Tuohy needle was then oriented perpendicular to the skin and was then advanced through the dermis and subcutaneous tissues.  Continuous injection of 0.5% preservative-free Xylocaine was used during the advancement of the Tuohy needle into the deeper spinous tissues.  A solution of 80 mg of Depo-Medrol with 2 cc of 1% Xylocaine injectable and 5 cc of normal saline were then injected into the epidural space.
Lumbar Epidural Steroid Injection - 3  ( Pain Management)
Description:  Lumbar epidural steroid injection for lumbar radiculopathy.

PREOPERATIVE DIAGNOSIS:  ,Lumbar radiculopathy, 724.4.,POSTOPERATIVE DIAGNOSIS:,  Lumbar radiculopathy, 724.4.,PROCEDURE:,  Lumbar epidural steroid injection.,ANESTHESIOLOGIST:,  Monitored anesthesia care,INJECTATE USED:,  10 mL of 0.5% lidocaine and 80 mg of Depo-Medrol.,ESTIMATED BLOOD LOSS:,  None.,COMPLICATIONS:,  None.,DETAILS OF THE PROCEDURE:,  The patient arrived at the preoperative holding area where informed consent, stable vital signs, and intravenous access were obtained.  A thorough discussion of the potential risks, benefits, and complications was made prior to the procedure including potential for post-dural puncture headache and its associated treatment as well as potential for increased neurological dysfunction and/or nerve root injury, infection, bleeding and even death.  There were no known EKG, chest X-ray, or laboratory contraindications to the procedure.,The patient has presented with significant apprehension concerning the proposed procedure and is fearful of movement during the procedure producing further neurological injury.  Arrangements will be made to have an anesthesia care provider present to provide heavier sedation while in the prone position with optimal airway management for improved patient safety and comfort.,The L4-L5 interspace was identified fluoroscopically.  A left paramedian insertion was marked and after sedation was established by the anesthesia department the skin and subcutaneous tissue over the proposed insertion site was infiltrated with 3 millimeters of 0.5% Lidocaine initially through a #25-gauge 5/8-inch needle later a #22-gauge 1-1/2-inch needle.,A number #18-gauge Tuohy epidural needle was then inserted and advanced with fluoroscopic guidance until passing just superior to the lamina of L5.  Needle tip position was confirmed in the anterior posterior fluoroscopic view.  The epidural space was located with the loss of pulsation technique.  Aspiration of the syringe was negative for blood or cerebrospinal fluid.  One millimeter of 0.9% preservative was injected with good loss resistance noted.,DISCHARGE SUMMARY:,  Following the completion of this procedure, the patient underwent monitoring in the recovery room and was discharged, to be followed as an outpatient.
Lumbar Discogram  ( Pain Management)
Description:  Lumbar discogram L2-3, L3-4, L4-5, and L5-S1.  Low back pain.

PREOPERATIVE DIAGNOSIS: , Low back pain.,POSTOPERATIVE DIAGNOSIS: , Low back pain.,PROCEDURE PERFORMED:,1.  Lumbar discogram L2-3.,2.  Lumbar discogram L3-4.,3.  Lumbar discogram L4-5.,4.  Lumbar discogram L5-S1.,ANESTHESIA:  ,IV sedation.,PROCEDURE IN DETAIL:  ,The patient was brought to the Radiology Suite and placed prone onto a radiolucent table.  The C-arm was brought into the operative field and AP, left right oblique and lateral fluoroscopic images of the L1-2 through L5-S1 levels were obtained.  We then proceeded to prepare the low back with a Betadine solution and draped sterile.  Using an oblique approach to the spine, the L5-S1 level was addressed using an oblique projection angled C-arm in order to allow for perpendicular penetration of the disc space.  A metallic marker was then placed laterally and a needle entrance point was determined.  A skin wheal was raised with 1% Xylocaine and an #18-gauge needle was advanced up to the level of the disc space using AP, oblique and lateral fluoroscopic projections.  A second needle, #22-gauge 6-inch needle was then introduced into the disc space and with AP and lateral fluoroscopic projections, was placed into the center of the nucleus.  We then proceeded to perform a similar placement of needles at the L4-5, L3-4 and L2-3 levels.,A solution of Isovue 300 with 1 gm of Ancef was then drawn into a 10 cc syringe and without informing the patient of our injecting, we then proceeded to inject the disc spaces sequentially.
Lumbar Epidural Steroid Injection  ( Pain Management)
Description:  Lumbar epidural steroid injection without fluoroscopy.  A 18-gauge Tuohy needle was placed into the epidural space, using loss of resistance technique, with no cerebrospinal fluid or blood noted.

PROCEDURE:,  Lumbar epidural steroid injection without fluoroscopy.,ANESTHESIA:,  Local sedation.,VITAL SIGNS:,  See nurse's records.,COMPLICATIONS:,  None.,DETAILS OF PROCEDURE:,  INT was placed.  The patient was in the sitting position and the back was prepped with Betadine.  Lidocaine 1.5% was used for skin wheal made between __________.  A 18-gauge Tuohy needle was placed into the epidural space, using loss of resistance technique, with no cerebrospinal fluid or blood noted.  After negative aspiration, a mixture of 10 cc of preservative free normal saline and 160 mg of preservative free Depo-Medrol was injected.  Neosporin and a band-aid were applied over the puncture site.  The patient was then placed in supine position.  The patient was discharged to the recovery room in stable condition.
Lumbar Sympathetic Block  ( Pain Management)
Description:  Bilateral lumbar sympathetic block.  The patient was in the prone position and the back prepped with Betadine.  The patient was given sedation and monitored. 

PROCEDURE:,  Bilateral lumbar sympathetic block.,ANESTHESIA: , Local sedation.,VITAL SIGNS:,  See nurse's notes.,COMPLICATIONS:,  None.,DETAILS OF PROCEDURE: , INT was placed.  The patient was in the prone position and the back prepped with Betadine.  The patient was given sedation and monitored.  Xylocaine 1.5% for skin wheal 6 cm lateral and slightly inferior to the bilateral L2 transverse process was made.  A 20-gauge, 15 cm LSB needle was then directed using AP and lateral fluoroscopic guidance until the tip of the needle was just inside the lateral aspect of the vertebral body and on the lateral projection, it was noted to be along the anterior vertebral body, at the junction of the upper two thirds, lower one third of the body.  After negative aspiration 3 cc of Omnipaque dye was injected showing linear spread along the body.  After negative aspiration 18 cc of 0.25% Marcaine was injected.  Attention was then directed to the L3 level with the tip of the needle guided to the junction of the upper one third, lower two third of L3.  At this point, after confirmation of the linear spread of dye along the anterior portion of the body, negative aspiration was performed and 18 cc of 0.25% Marcaine was injected.  Neosporin and band-aids were applied over the sites.  The patient was taken to the outpatient recovery room in stable condition.
Knee Injection - 1  ( Pain Management)
Description:  Osteoarthritis of the right knee.  Right knee joint steroid injection.

PROCEDURE: , Right knee joint steroid injection.,PREOPERATIVE DIAGNOSIS:,  Osteoarthritis of the right knee.,POSTOPERATIVE DIAGNOSIS:,  Osteoarthritis of the right knee.,PROCEDURE:  ,The patient was apprised of the risks and the benefits of the procedure and consented.  The patient's right knee was sterilely prepped with Betadine.  A 4 mg of dexamethasone was drawn up into a 5 mL syringe with a 3 mL of 1% lidocaine.  The patient was injected with a 1.5-inch 25-gauze needle at the medial aspect of his right flexed knee.  There were no complications.  The patient tolerated the procedure well.  There was minimal bleeding.  The patient was instructed to ice his knee upon leaving clinic and refrain from overuse over the next 3 days.  The patient was instructed to go to the emergency room with any usual pain, swelling, or redness occurred in the injected area.  The patient was given a followup appointment to evaluate response to the injection to his increased range of motion and reduction of pain.
Lumbar Facet Injections  ( Pain Management)
Description:  Lumbar facet injections done under fluoroscopic control.  Lumbar spondylosis.

PREOPERATIVE DIAGNOSIS:,  Lumbar spondylosis.,POSTOPERATIVE DIAGNOSIS:,  Lumbar spondylosis.,OPERATION PERFORMED:,  Lumbar facet injections done under fluoroscopic control.,ANESTHESIA:,  Local and IV.,COMPLICATIONS:,  None.,DESCRIPTION OF PROCEDURE:  ,After proper consent was obtained, the patient was taken to the fluoroscopy suite and placed in a prone position on a fluoroscopy table with abdominal rolls in place.  The skin was prepped and draped in a sterile classical fashion.  The patient was monitored with blood pressure cuff, electrocardiogram, and pulse oximeter.  The patient was given oxygen, intravenous sedation and analgesics as needed.  The facets were identified and marked under fluoroscopic control by rotating the C-arm obliquely, laterally and caudocranial as needed for optimal visualization of the facet joint's "Scottie dog" and the opening of the facet.,After each facet joint was identified and marked, local anesthesia was infiltrated subcutaneously and deep over each of the identified facets.  A 22-gauge spinal needle was then utilized to cannulate the facet joint under fluoroscopic control utilizing a gun barrel technique.  After negative aspiration, 0.25 - 0.5 cc of Omnipaque 240 contrast media was injected into the facet as an arthrogram to visualize the joint and the capsule.  After another negative aspiration, 1cc of a 10cc solution of Marcaine 0.5% and 100 milligrams of methyl prednisolone acetate was injected into each facet.  The patient tolerated the procedure well without apparent difficulty or complication unless otherwise noted.
Lumbar Epidural Steroid Injection - 1  ( Pain Management)
Description:  Lumbar epidural steroid injection, intralaminar approach, seated position.  An 18-gauge Tuohy needle was then placed in the epidural space utilizing a midline intralaminar approach with loss of resistance technique and a saline-filled syringe.

OPERATION:,  Lumbar epidural steroid injection, intralaminar approach, seated position.,ANESTHESIA:,
Lower Extremity Pain  ( Pain Management)
Description:  Evaluation for right L4 selective nerve root block.

REASON FOR REFERRAL:,  Evaluation for right L4 selective nerve root block.,CHIEF COMPLAINT:,
Knee Injection - 2  ( Pain Management)
Description:  She is a 14-year-old Hispanic female with history of pauciarticular arthritis in particular arthritis of her left knee, although she has complaints of arthralgias in multiple joints.  Under general anesthesia, 20 mg of Aristospan were injected on the left knee.

INDICATIONS FOR PROCEDURE: , The patient was here for joint injection.  She is a 14-year-old Hispanic female with history of pauciarticular arthritis in particular arthritis of her left knee, although she has complaints of arthralgias in multiple joints.  What bother her the most is the joint swelling of her left knee that has been for several months.  She has been taking Naprosyn on her last visit.  She was feeling better but still has significant symptoms especially when she was active.  After evaluation in the clinic, she decided to have a joint injection as it was discussed before.  I discussed the side effects and the complications with the parents and the patient and the possibility of doing it in the clinic, but she decided that she did not want to do it in the clinic and she wanted to be sedated for this.,DESCRIPTION OF PROCEDURE: , So under aseptic technique and under general anesthesia, 20 mg of Aristospan were injected on the left knee.  No fluid was obtained.  Her swelling was about 1+.  No complications.  No bleeding was observed, and the patient tolerated the procedure without any complications or side effects.  After that she went to the recovery room where is going to be discharged with her parents and see her back in the clinic for re-evaluation in a few weeks after the procedure.  If the patient has any problems overnight, she is going to call us.  If she had any fevers or strange swelling, she is to call us for advice.  We will see her in the clinic as scheduled.
Intercostal block - 1  ( Pain Management)
Description:  Intercostal block from fourth to tenth intercostal spaces, left.  Chest pain secondary to fractured ribs, unmanageable with narcotics.

PREPROCEDURE DIAGNOSIS:,  Chest pain secondary to fractured ribs, unmanageable with narcotics.,POSTPROCEDURE DIAGNOSIS:,  Chest pain secondary to fractured ribs, unmanageable with narcotics.,PROCEDURE: , Intercostal block from fourth to tenth intercostal spaces, left.,INDICATIONS: , I was requested by Dr. X to do an intercostal block on this lady who fell and has fractured ribs, whose chest pain is paralyzing and not responding well to increasing doses of narcotics.,PROCEDURE DETAIL:,  After obtaining an informed consent with the patient on her bedside, she was placed in the right decubitus position with the left side up.  The posterior left chest wall was prepped and draped in the usual fashion and then a mixture of 1% Xylocaine 20 mL and Marcaine 0.25% 20 mL were mixed together and the intercostal spaces from the fourth to the tenth ribs were anesthetized.  A total of 30 mL worth of solution was used.  I also injected some local anesthetic subcutaneously into an area of contusion in the left lumbar area.,The patient tolerated the procedure well.  She had no respiratory distress.  Immediately, the patient felt some relief from the pain.  Chest x-ray was ordered for the following day.
Kenalog Injection  ( Pain Management)
Description:  Left L5 transforaminal epidural steroid injection with 40 mg of Kenalog under fluoroscopic guidance.  The patient is a 78-year-old female with back pain referring into the left side. 

PROCEDURE:,  Left L5 transforaminal epidural steroid injection with 40 mg of Kenalog under fluoroscopic guidance.,INDICATIONS:  ,The patient is a 78-year-old female with back pain referring into the left side.  She has had a couple of epidurals in the past, both of which led to only short-term improvement with intralaminar and caudal placements.  Therefore, transforaminal approach was selected for today's procedure.,Risks and benefits were discussed with the patient.  She agreed to accept the risks and signed informed consent to proceed.,PROCEDURE DETAILS:,  The patient was placed prone on the table.  The skin was thoroughly cleansed with betadine swabs x3 and wiped off with a sterile gauze.  The subcutaneous intramuscular and interligamentous region was anesthetized with buffered 1% lidocaine.,A 5-inch, 22-gauge spinal needle was directed under intermittent fluoroscopic guidance using an oblique approach at the opening of the L5 nerve root.  Once bony contact was made, a lateral was obtained and showed the needle tip to be against the posterior spinal body in the anterior epidural space.  Then an AP view was obtained which showed the needle tip to be below the 6 o'clock position of the pedicle.,EPIDUROGRAM: , Omnipaque 300, 1 mL, was placed through the foraminal opening of the L5 nerve root on the left.  This did show dye spread pattern which was narrowed consistent with foraminal stenosis.  The dye did traverse the foraminal opening and was seen spreading around the pedicle into the anterior epidural space.  It was also spreading peripherally along the L5 nerve root.,The patient tolerated the procedure well.  She did feel that the needle tip was placed at the epicenter of her pain, and this was improved with the placement of the anesthetic.,I will see the patient back in the office in the next few weeks to monitor response of the injection.
Knee Injection  ( Pain Management)
Description:  Knee injection

The patient was told that the injection may cause more pain for two to three days afterwards and if this occurred they would best be served by icing the area 15-20 minutes every 6 hours.  The patient was advised to protect the knee by limiting repetitive bending, squatting , kneeling and excessive heavy use for a week.  Also, they were asked to follow up in two weeks p.r.n.
Hypogastric Plexus Block  ( Pain Management)
Description:  Standard hypogastric plexus block procedure note.

NAME OF PROCEDURE:,  Hypogastric plexus block.,ANESTHESIA:,  Local.,PROCEDURE: , The patient was in the operating room in the prone position with the back prepped and draped in sterile fashion.  Local anesthesia was used to make a skin wheal 8-10 cm lateral to the L4 spinous process bilaterally from the midline.  Starting from the left side, a 20-gauge 6-inch needle was placed to the left L5-S1 facet level under AP fluoroscopic view.  On lateral view, the tip of the needle was at the inferior one-third of the LS vertebral body, anterior aspect.  Next 5 cc of Omnipaque dye was injection showing a linear spread along the anterior portion of L5 down the sacral promontory.  After negative aspiration 18 cc of 0.25% Marcaine plus 40 mg of Depo-Medrol was injection.  There were no complications.  The above sequence was repeated for the right side.  There were no complications.  The patient was discharged back to outpatient recovery in stable condition.
Epidural Steroid Injection - 2  ( Pain Management)
Description:  Caudal epidural steroid injection without fluoroscopy.

PROCEDURE:  ,Caudal epidural steroid injection without fluoroscopy.,ANESTHESIA:,  Local sedation.,VITAL SIGNS: , See nurse's records.,PROCEDURE DETAILS: , INT was placed.  The patient was in the prone position.  The back was prepped with Betadine.  Lidocaine 1.5% was used to make a skin wheal over the sacral hiatus.  A 18-gauge Tuohy needle was then placed into the epidural space.  There were no complications from this (no blood or CSF).  After negative aspiration was performed, a mixture of 10 cc preservative free normal saline plus 160 mg preservative free Depo-Medrol was injected.  Neosporin and band-aid were applied over the puncture site.  The patient was then placed in supine position.  The patient was discharged to outpatient recovery in stable condition.
Intercostal Block  ( Pain Management)
Description:  Intercostal block, left.   Severe post thoracotomy pain.

PREOPERATIVE DIAGNOSIS: , Severe post thoracotomy pain.,POSTOPERATIVE DIAGNOSIS: , Severe post thoracotomy pain.,PROCEDURE: , Intercostal block, left.,PROCEDURE DETAIL: , With the patient in the ICU bed who was having a large amount of intravenous narcotic to control his thoracotomy pain, after obtaining informed consent, his left posterior chest was prepped and draped in the usual fashion and Marcaine 0.025% was injected in the spaces four to eight sequentially.  A total of 40 mL of Marcaine was used.,The patient tolerated the procedure well and experienced immediate benefit out of the procedure.