Question about medial branch RFA

[smarterchild]

hi everyone. recently, i have noticed more patients complaining of post-ablation soreness lasting 2 weeks or so after cervical and lumbar RFs. I know some degree of neuritis is to be expected, but its occurring more frequently. In fellowship, i was trained to have the needle on os prior to lesioning. A colleague of mine told me tends to touch periosteum and then pull the needle back in the soft tissue prior to testing and lesioning. He seems to think that reduces post-procedural soreness.

I was just wondering what you guys thought about this and what your experience has been?

thanks!

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[SSdoc33]

hi everyone. recently, i have noticed more patients complaining of post-ablation soreness lasting 2 weeks or so after cervical and lumbar RFs. I know some degree of neuritis is to be expected, but its occurring more frequently. In fellowship, i was trained to have the needle on os prior to lesioning. A colleague of mine told me tends to touch periosteum and then pull the needle back in the soft tissue prior to testing and lesioning. He seems to think that reduces post-procedural soreness.

I was just wondering what you guys thought about this and what your experience has been?

thanks!

the nerve is on the bone. if you want to withdraw, you are getting farther from it and making for a less effective procedure. post-RF neuritis is a sign that you have done the procedure correctly

 

[smarterchild]

great! thanks for the input!

 

[unchockey21]

hi everyone. recently, i have noticed more patients complaining of post-ablation soreness lasting 2 weeks or so after cervical and lumbar RFs. I know some degree of neuritis is to be expected, but its occurring more frequently. In fellowship, i was trained to have the needle on os prior to lesioning. A colleague of mine told me tends to touch periosteum and then pull the needle back in the soft tissue prior to testing and lesioning. He seems to think that reduces post-procedural soreness.

I was just wondering what you guys thought about this and what your experience has been?

thanks!

Are you injecting steroid after the RF?

 

[smarterchild]

yes! i injected 10mg of dexa with some 0.25% marcaine divided over the 3 sites. do you have any other suggestions>

 

[lobelsteve]

yes! i injected 10mg of dexa with some 0.25% marcaine divided over the 3 sites. do you have any other suggestions>

Use 2-3mg dex or none. Thats a full dose x2.

 

[BobBarker]

I bet you are just getting better at it!

 

[unchockey21]

yes! i injected 10mg of dexa with some 0.25% marcaine divided over the 3 sites. do you have any other suggestions>

How long and at what temp are you burning? How many lesions?

 

[DODOCSS]

dex lasts 12 minutes, drop a few mg of depo

 

[Ducttape]

Dex is fine. You don’t need it to last more than a couple of weeks.

Better yet, don’t use any and inform patients it will take 3-4 weeks to set and to expect the increased pain. Aggressive ice after.

Or... when they say something, get up on your chair and scream “Hallelujah, I hit the spot!”..

 

[smarterchild]

Thanks for the input guys!

I usually burn for 90 seconds at 80 deg C. I’ve only had a problem with a few patients on the hundreds of RFs I’ve done but I was just curious if I could improve in anyway. I’ll give depo a shot and see if I get better results!

 

[clubdeac]

Anyone else doing 90 degrees after that one paper showed improved outcomes? I started burning at 90 degrees a month or so ago. haven't seen them in f/u yet though

 

[lobelsteve]

90 in back, 80 in neck

 

[Ducttape]

Anyone else doing 90 degrees after that one paper showed improved outcomes? I started burning at 90 degrees a month or so ago. haven't seen them in f/u yet though

i do. 90 in back. 80 or 90 in neck. seems better. not much increase in pain because im using 2% lido (thanks Lig!)

 

[thecentral09]

i do. 90 in back. 80 or 90 in neck. seems better. not much increase in pain because im using 2% lido (thanks Lig!)

So I was recently told that 2% Lido is on national backorder. I have always used it as well. Any suggestions on what else to use in its place?

 

[Lecithin5]

i do. 90 in back. 80 or 90 in neck. seems better. not much increase in pain because im using 2% lido (thanks Lig!)

4% lido FTW

 

[lobelsteve]

2cc of 1%. Anti-SIS.