CPT® Code 64449

Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)

The procedure described by CPT® Code 64449 involves the administration of anesthetic agents and/or steroids into the lumbar plexus through a continuous infusion method. This procedure is typically performed to provide pain relief in the lower body, particularly for conditions affecting the hip and leg. The lumbar plexus is a network of nerves located in the lower back that supplies sensation and motor function to the lower limbs. The posterior approach refers to the technique used to access the lumbar plexus from the back. During the procedure, a catheter is placed to allow for the continuous delivery of the medication, ensuring prolonged analgesic effects. The process begins with the identification of the appropriate injection site, which is usually located between the iliac crests, followed by the cleansing and preparation of the skin. A local anesthetic may be administered to minimize discomfort during the procedure. A specialized needle, often connected to a peripheral nerve stimulator, is then carefully advanced into the psoas compartment, where the lumbar plexus is located. The correct placement of the needle is confirmed through nerve stimulation, which elicits specific muscle contractions. Following this, aspiration is performed to check for the presence of blood or cerebrospinal fluid, ensuring that the needle is not in a blood vessel or the spinal canal. A test dose of the anesthetic is administered to further confirm proper placement. Once the initial injection is completed, a catheter is inserted to facilitate continuous infusion of the anesthetic agent and/or steroid, providing ongoing pain relief. The effectiveness of the block is assessed by evaluating the analgesia in the left leg and hip, and the catheter's position is verified to prevent complications associated with incorrect placement.