Dr. McKenna, Dr. Ruggeroli, Dr. Helmi and the staff at McKenna, Ruggeroli and Helmi Pain Specialists understand that the anticipation of any medical procedure can cause anxiety. In order to ease such anxiety, we have provided a brief explanation of what to expect with your procedure.
McKenna, Ruggeroli and Helmi Pain Specialists attempts to arrange for all appropriate procedures to be performed at an ambulatory surgery center (ASC), ensuring patient safety, comfort and convenience. Some minor injections are performed in the office. Some insurances dictate that certain procedures be performed in a hospital.
Our preferred facility is the Surgical Arts Center, an ASC designed and staffed to accommodate the specific requirements of the practice of interventional pain. An accredited ASC provides expert physician and nursing care and is able to effectively deal with any and all medical emergencies, either on-site or upon transfer to a hospital through a pre-arranged protocol. Very few pain procedures have complications, but occasionally a patient experiences an exacerbation of a pre-existing medical problem, a reaction to a medication or an unexpected reaction to an injection. In such cases, our patients can be confident that the Surgical Arts Center will provide appropriate and timely expert care. The Surgical Arts Center combines a friendly, efficient and cost-effective environment with state-of-the-art medical expertise.
McKenna, Ruggeroli and Helmi Pain Specialists attempts to make your time at the Surgical Arts Center pleasant and efficient, getting you in and out of the facility as quickly as possible while optimizing medical safety. Because of the demand for pain intervention, you will be one of many patients receiving a procedure that day. Because of these time constraints, Drs. McKenna, Ruggeroli and Helmi will not write prescriptions or evaluate any new problems at the time of the procedure. Unanticipated circumstances occasionally delay the schedule, resulting in crowding of the waiting area. Every effort is made to avoid this situation, but if it occurs, your understanding and patience is greatly appreciated. Our goal is eliminate inconvenient delays by practicing efficient and effective patient care.
Before the Procedure
Please refrain from eating or drinking for four hours before an injection procedure and eight hours before a surgical procedure. Unless instructed otherwise, you may take your regular medications with sips of water. If you take a blood thinner, an anti-inflammatory medication or aspirin, please inform our office and specific instructions will be given. You will need to arrange for a driver to take you home after your procedure. A driver is necessary because some medications may negatively affect your ability to safely operate a motor vehicle. While most patients feel completely normal after their procedure, this is a precaution that is necessary and is the standard of care in our community. Please arrange to be at the surgery center one-half hour before your procedure. Refer to the maps and directions on this website to plan your transportation.
The Surgical Arts Center is located within the Thomas and Mack Medical Plaza and parking is ample and convenient. See the map provided in the Surgery Centers section. For your convenience, a patient drop-off area is available adjacent to the entrance. Upon entering the lobby, proceed to the elevator or stairs and ascend to the second floor where signs will direct you to the front desk and waiting area. The receptionist will ask you for several pieces of information, including identification and proof of insurance. You will be required to sign a few documents. If a co-pay is required by your insurance, this will be collected at this time.
A staff member will escort you to a changing area in order to change into a gown. Most procedures do not require complete disrobement and you will be allowed to wear your pants and shoes. You will be taken to a private area where a nurse will place a small intravenous catheter into your arm or hand. This catheter will allow for the administration of appropriate medications during your procedure. If any problem were to occur, this intravenous access will be important in allowing for the administration of emergency medications. After the intravenous catheter is placed, you will be escorted to another area to wait for your procedure.
You will be escorted to a procedure room equipped with a special table, a fluoroscopy unit (a type of x-ray machine) and full armament of state-of-the-art anesthesia and resuscitative equipment. Your vital signs will be monitored. You will be accompanied by a nurse, a surgical technician, a radiology technician and Dr. McKenna, Dr. Ruggeroli or Dr. Helmi. Under the supervision of Dr. McKenna, Dr. Ruggeroli or Dr. Helmi a registered nurse will administer the appropriate amount of sedation. Some diagnostic procedures require that the patient remain completely awake and very little, if any, sedation will be used. The correct amount and type of sedation is individualized for each patient, a practice mastered by our doctors during their years of work and training as board certified anesthesiologists. A separate anesthesiologist is not employed for routine injection procedures. However, if the procedure requires a surgical incision, such as the implantation of an intraspinal drug delivery system or a spinal cord stimulator, an anesthesiologist will be involved. In such cases, you will receive a separate bill from the anesthesiologist.
The skin overlying the anatomic area of the procedure will be prepped and scrubbed with an antiseptic solution. The fluoroscopy unit will be used by Dr. McKenna, Dr. Ruggeroli or Dr. Helmi to assure the precise anatomic location of the injection. A local anesthetic will be used to anesthetize the skin and a small needle will be inserted through the skin. This needle will be directed into the correct location. Contrast will be used to confirm that the needle is correctly placed and only then will the medication be injected. During the injection, you may feel sensations called paresthesias if a nerve is in proximity to the injection site. Some injections, such as disc stimulation, may actually reproduce your typical pain. At the conclusion of the procedure, the needle will be removed and you will be returned to the recovery area. No dressings are usually required.
Your vital signs, neurological examination and mental capacity will be assessed immediately after the procedure. Appropriate care will be delivered depending upon your needs. The vast majority of patients leave the recovery area after about 30 minutes. If there is any problem, Dr. McKenna, Dr. Ruggeroli or Dr. Helmi will be notified and appropriate treatment will be administered. In a “worst-case” scenario, the patient will be transported by ambulance to Summerlin Hospital, located approximately two miles from the facility.
After confirming that your transportation is present, you will be escorted downstairs and helped into your vehicle.
Most patients do very well after the intervention. Occasionally, side-effects may occur, usually minor reactions to medications, such as nausea, headache or sedation. Rest and time usually resolve these symptoms. Some patients may experience an increase of their typical pain for a few days and it is not uncommon to have some minor pain or swelling at the site of the needle insertion. For these pains, we recommend ice and rest. Any neurological change such as weakness or loss of sensation should be reported immediately. Any problem that persists for more than 24 hours should be reported. The staff at McKenna, Ruggeroli and Helmi Pain Specialists will happily receive your call and will arrange for appropriate medical care if needed.