Drg Rf

[PainDr]

I've scheduled a pt for a 4 level thoracic DRG RF (post herpetic neuralgia). I haven't done one of these since fellowship and don't remember which parameters should be used. For MB RF, I usually use 85 degrees for 90 secs, but my reference says that for DRG you should use 65 degrees for 60 secs. With such close proximity to the cord, it does seem that a lower temp would be safer. What parameters do you guys use?

Also, how should this be coded? I seem to remember that there's not a code for "DRG RF" and that it should be coded as "peripheral nerve RF". Thanks!

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[PainDr]

Oh come on...no one has an opinion or experience with this procedure? BTW, Steve, where's Paz? Haven't seen him around lately.

 

[CB1Antagonist]

We do thoracic DRG RF routinely for post thoracotomy pain and lung cancer with chest wall spread. The usual algorithm is diagnostic thoracic transforaminal steroid injection followed by pulsed RF (42 c for 120 seconds). If pulsed RF does not give long lasting relief, we perform conventional RF (80 C for 90 seconds)

I would caution against using RF for PHN, given the significant component of deafferentation pain involved in this disease. The best best would be thoracic ESI, medical management and SCS trial if refractory.

 

[lobelsteve]

We do thoracic DRG RF routinely for post thoracotomy pain and lung cancer with chest wall spread. The usual algorithm is diagnostic thoracic transforaminal steroid injection followed by pulsed RF (42 c for 120 seconds). If pulsed RF does not give long lasting relief, we perform conventional RF (80 C for 90 seconds)

I would caution against using RF for PHN, given the significant component of deafferentation pain involved in this disease. The best best would be thoracic ESI, medical management and SCS trial if refractory.

Similar, but rarely see any patients of this type in our practice. We will not go to a thermal lesion due to risk as stated above. We prefer interlaminar at T12-L1 and run a catheter up to and into the foramen (inside out technique).

BTW, PAZ is in LA- maybe no internet on the bayou.

 

[PainDr]

Thanks for the input. Blocks provided good but transient results...I did intercostal blocks (partial response for several weeks). Pt is elderly and was unable to tolerate multiple types of medications. She still has good sensation and that combined with her response to blocks would indicate minimal deafferentation. Was unsuccessful in getting approval for pulsed. In this situation would anyone pursue lesioning? What about using 45 degrees?

 

[Mister Mxyzptlk]

One workaround: Precert TFESI. Then use a RF cannula for the TFESI. While you're there do the PRF.

DRG RF is supposed to be done at 65 degrees instead of 80. I don't know why they picked that number.

 

[Doctodd]

Similar, but rarely see any patients of this type in our practice. We will not go to a thermal lesion due to risk as stated above. We prefer interlaminar at T12-L1 and run a catheter up to and into the foramen (inside out technique).

BTW, PAZ is in LA- maybe no internet on the bayou.

How did you code this Steve? There is no thoracic neuroplasty code that i could find....only Lumbar epidural neuroplasty.....64714.

T

 

[PainDr]

Gorback,

How much do you oblique for the TESI's? The reason I ask is because, for thoracic DRG RF, Gauci recommends only 10-15 degrees which doesn't seem like nearly enough.

Thanks!

 

[PainDr]

Well, I chickened out. I had another conversation with the patient about the possibility of neuritis and deafferentation pain and convinced her to try a second round of blocks. I'm also going to talk to her insurer again about pulsed. However, now I have a second pt who wants the procedure. He has post thoracotomy pain syndrome. In the past, he has undergone blocks and pulsed RF, but now wants to try ablation. Does anyone know the actual risk of developing neuritis and/or deafferentation pain with DRG ablation? Is there any difference in risk between post herpetic neuralgia and post thoractomy pain syndrome? I've done a literature search but haven't found anything. Thanks!