RFA under general anesthesia

[ateria radicularis magna]

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Any thoughts on this?

How do those who do GA RFA do stim? Just motor? Is there any literature to support this as a good safety measure? I am not asking in order to prove a point or to get on a soap box or whatever; I truly want to know.

 

[willabeast]

i think it is possible to do RFA under GA safely, but seems like an unnecessary risk, and might be indefensible if litigation ensues. so i would not do it unless some really good reason - however - the original facet denervations were done under GA (with a knife).

 

[deleted185747]

Bogduk states, at least for cervical, fluoroscopic position is superior to testing and numbs and burns several locations on the same facet. I think a proper lateral will keep you out of trouble.

 

[lonelobo]

IF someone requires GA for an RF, they probably don't need an RF

 

[ateria radicularis magna]

i think it is possible to do RFA under GA safely, but seems like an unnecessary risk, and might be indefensible if litigation ensues. so i would not do it unless some really good reason - however - the original facet denervations were done under GA (with a knife).

Yes, it seems like an unnecessary risk. I did not realize that interventionalists did asleep RFA until recently, and it does seem like a risk. I understand there are competing factors, like billing for "services rendered" and the many benefits of a queit, motionless patient, but...I also heard mention of a cervical RF case under GA gone wrong. I wonder if any fellowships are teaching RF under deep sedation, such that the patient does not really respond.

Does anyone out there do RFA under GA or deep sedation, and if so, can you share your perspective?

 

[Ligament]

I've done it under MAC a FEW times, lumbar only. For patients on very very high chronic opioids who I could not sedate otherwise. No, I did not prescribe these opioids to them.

Go over additional risks with them in detail.

 

[ateria radicularis magna]

I've done it under MAC a FEW times, lumbar only. For patients on very very high chronic opioids who I could not sedate otherwise. No, I did not prescribe these opioids to them.

Go over additional risks with them in detail.

Thank you--how did you think about stimulation for these particular cases (I.e. Did you use motor testing and at what strength?)

 

[Dr. Ice]

Maybe the anesthesia pain docs are double dipping with the GA...

 

[bedrock]

IF someone requires GA for an RF, they probably don't need an RF

This is the key thing. I find that the more the patient demands they "must be asleep" for their RFA, the more supratentorial their pain, and the lower their relief from any RF procedure.

Principle holds extremely true for lumbar RF, not quite as much for cervical RF, which is somewhat more legitimately a source of anxiety and pain.

I use light IV sedation for 30-50% of cervical RF, and will provide on request for lumbar RF.

 

[101N]

You're treating anxiety here, not pain.

 

[bedrock]

You're treating anxiety here, not pain.

Very true, but it's easier to be anxious about a needle in your neck compared to your low back. I find that a higher percentage of patients need light IV sedation for CESI compared to LESI.

 

[lobelsteve]

Very true, but it's easier to be anxious about a needle in your neck compared to your low back. I find that a higher percentage of patients need light IV sedation for CESI compared to LESI.

You mean like 0.01% vs 0.00%?

 

[bedrock]

You mean like 0.01% vs 0.00%?

Yes, still small numbers of people who truly need it, vs think they do.