Post RFA Neuritis

[MitchLevi]

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On a side note, do you guys see good results in your cervical RFA's even when you don't get good twitch responses during motor stim? I used to always get strong muscle twitches in the neck but they've been absent on the last few. Wondering if they won't end up getting any relief. We'll see....

I think twitch in the neck should be present the vast majority of the time. I also think your lateral views should be perfect.

 

[clubdeac]

What are your thoughts. lumbar RFA last week. Needle position looked prefect and no LE motor twitch however patient complained of some radiating pain down leg during burn. Nothing excruciating. Pulled back and continued burn. Eased up but then came back. Completed burn with some leg discomfort but again nothing severe. Called in Monday with severe burning leg pain. Said it started the next morning and states he can’t put weight on it without sig pain. No weakness

Sent steroids and Oxy and already on lyrica. Hoping this calms down but anyone ever experience this before

 

[painfree23]

What are your thoughts. lumbar RFA last week. Needle position looked prefect and no LE motor twitch however patient complained of some radiating pain down leg during burn. Nothing excruciating. Pulled back and continued burn. Eased up but then came back. Completed burn with some leg discomfort but again nothing severe. Called in Monday with severe burning leg pain. Said it started the next morning and states he can’t put weight on it without sig pain. No weakness

Sent steroids and Oxy and already on lyrica. Hoping this calms down but anyone ever experience this before

How many levels? Did you it steroid during RF?

 

[painfree23]

On a side note, do you guys see good results in your cervical RFA's even when you don't get good twitch responses during motor stim? I used to always get strong muscle twitches in the neck but they've been absent on the last few. Wondering if they won't end up getting any relief. We'll see....

When do u put the local? If using 2% lido before you check twitches, could be absent

 

[hopefulgasman]

When do u put the local? If using 2% lido before you check twitches, could be absent

I test with no local first and usually get a twitch. After local, the twitch is absent.

 

[clubdeac]

When do u put the local? If using 2% lido before you check twitches, could be absent

I’ve been putting local in before testing for awhile now and usually still get some twitch if I test before the local has had time to set up. I’m really hoping this calms down in the next week or two

 

[clubdeac]

How many levels? Did you it steroid during RF?

3 levels. From her description it appears L3 root got heated. No steroid during burn

 

[Ducttape]

yes have had it happen.

seemed more consistent with facet dermatomal distribution rather than radiculopathy when i "mapped" it out.

in most recent incident, pain resolved after 2 months and patient had durable relief. when i repeated RFA - at patient's insistence - used 80 degrees instead of 90 without it recurring.


i put the local in after motor testing. place needles in oblique, AP then while going to lateral place probes, lateral image, then test. if okay, then local, and wait til temp goes up a couple of degrees, (45 seconds to a minute), then lesion.

i guess i could put in the lido while waiting for lateral, but i want to view the image first.

 

[Orin]

For efficiency, I have been put in bupi 0.25 before testing to get the deep stuff. It should make the test more sensitive/robust as you'll get more spread of the electric field, but the kinetics of bupi being slower make it less likely to cause motor block, especially at that concentration.

 

[callmeanesthesia]

For efficiency, I have been put in bupi 0.25 before testing to get the deep stuff. It should make the test more sensitive/robust as you'll get more spread of the electric field, but the kinetics of bupi being slower make it less likely to cause motor block, especially at that concentration.

Motor block onset time for lidocaine is 10 minutes or more: Onset times and duration of analgesic effect of various concentrations of local anesthetic solutions in standardized volume used for brachial plexus blocks - PMC

It’s dependent on the thickness and type of nerve but what we care about here is the spinal nerve root which is quite thick. Put in 2% lido then motor test 30 seconds later and you won’t block a leg twitch. The little A delta and C fibers that make it hurt when we touch the periosteum numb much faster. I like to touch bone a little posterior and add 1/2 mL of lido. Makes the fine tuning the needle adjustment much less painful without risking the nerve roots.

 

[Orin]

Motor block onset time for lidocaine is 10 minutes or more: Onset times and duration of analgesic effect of various concentrations of local anesthetic solutions in standardized volume used for brachial plexus blocks - PMC

It’s dependent on the thickness and type of nerve but what we care about here is the spinal nerve root which is quite thick. Put in 2% lido then motor test 30 seconds later and you won’t block a leg twitch. The little A delta and C fibers that make it hurt when we touch the periosteum numb much faster. I like to touch bone a little posterior and add 1/2 mL of lido. Makes the fine tuning the needle adjustment much less painful without risking the nerve roots.

Yeah, but 0.25% bupi is even slower and weaker of a motor block. The time to sensory block really isn't that different for the small fibers we're aiming for I'd agree, so saves a step. It sounds like you prefer to do it on the way in, and I'm just not that brave yet.