Tined RF Products?

[FacetFella]

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I've been using Avanos coolief for a while, but one of their reps just showed me the Trident product. Seems pretty legit...but wondering if anyone has experience using it? How does it compare with Stryker Venom or other tined options? Curious when people are using Trident instead of Coolief.

 

[bedrock]

I've been using Avanos coolief for a while, but one of their reps just showed me the Trident product. Seems pretty legit...but wondering if anyone has experience using it? How does it compare with Stryker Venom or other tined options? Curious when people are using Trident instead of Coolief.

Been discussed several times. May want to do a search.

 

[clubdeac]

I've been using Avanos coolief for a while, but one of their reps just showed me the Trident product. Seems pretty legit...but wondering if anyone has experience using it? How does it compare with Stryker Venom or other tined options? Curious when people are using Trident instead of Coolief.

i used coolief for years. Have tried their Trident needles a few times on very difficult scoliotic spine with meh results. Not sure if the lackluster results were due to patient anatomy with multiple pain generators related to severe degenerative scoliosis or due to the technology. I'm guessing the former

I still get more satisfaction from a perfectly placed 18g RFA needle using Bogduk's approach

 

[Agast]

I thought the only people still using Coolief were CRNAs. Are you a physician?

 

[clubdeac]

I thought the only people still using Coolief were CRNAs. Are you a physician?

Best RF results I’ve ever had were with coolief for the SI joint and thoracic arthropathy. Consistently 18 to 24 months relief for SI joint pain. It was freaking awesome. I think it’s really only feasible in the VA or HOPD

 

[Ferrismonk]

Coolief doesn't make sense financially outside of the hospital.

I've been using Tridents for a while now and I like them. Approach is more direct and I place it on the bone at the junction of the TP and SAP. I don't walk off. Good results. Very fast.

 

[TIVAndy]

i use nimbus needles for SI RF and genicular RF

 

[au bon pain]

At this point I like nimbus more than coolief—can use a regular generator and much less expensive. Cables/probles are equally annoying though

 

[lobelsteve]

Funny thread. I just got telesurvey to discuss the products. Nimbus, venom, sidekick, trident, cooled.

 

[au bon pain]

Funny thread. I just got telesurvey to discuss the products. Nimbus, venom, sidekick, trident, cooled.

Yeah 1-time poster + very specific user name + post with perfect company/product capitalization…all definitely stood out.

@FacetFella , intra-articular traumeel is greatly preferred to either option you mentioned.

 

[1 Up]

I've been using Avanos coolief for a while, but one of their reps just showed me the Trident product. Seems pretty legit...but wondering if anyone has experience using it? How does it compare with Stryker Venom or other tined options? Curious when people are using Trident instead of Coolief.

Assuming you aren't a bot, or a plant, or a mole, or whatever the hell you probably are... I've done a side by side comparison with Trident vs Coolief in pork loin. If you run the Trident at 80-85C for 2.5 min (same time as we run Coolief), it's a similar lesion. I only use Trident for cervical RF because of the limited tissue purchase. Coolief for all lumbar lesion, because it is slightly larger than Trident, but there is a strong argument to just use Trident.

 

[mille125]

Yeah 1-time poster + very specific user name + post with perfect company/product capitalization…all definitely stood out.

@FacetFella , intra-articular traumeel is greatly preferred to either option you mentioned.

That is principally why I have given no response.

 

[Orin]

Free opinions are worth what you pay for them? But it's probably not a horrible idea for guerrilla research

I'll add my thoughts that Coolief's cost profile makes it hard to do more than one lesion at a time but the approach independence being greater makes for better outcomes with complex cases or for the poorly trained.

I'm still expecting to stop doing RFA when the IA RTX agents launch

 

[callmeanesthesia]

Free opinions are worth what you pay for them? But it's probably not a horrible idea for guerrilla research

I'll add my thoughts that Coolief's cost profile makes it hard to do more than one lesion at a time but the approach independence being greater makes for better outcomes with complex cases or for the poorly trained.

I'm still expecting to stop doing RFA when the IA RTX agents launch

I feel like that would be iffy for facets. Plenty of bad facets that are so overgrown you couldn’t get access to the actual joint without a drill. Also what happens if it spills into the epidural space?

 

[clubdeac]

Free opinions are worth what you pay for them? But it's probably not a horrible idea for guerrilla research

I'll add my thoughts that Coolief's cost profile makes it hard to do more than one lesion at a time but the approach independence being greater makes for better outcomes with complex cases or for the poorly trained.

I'm still expecting to stop doing RFA when the IA RTX agents launch

What’s RTX? Same as Traumeel?

 

[interjectionreflection]

I liked Trident but found it to expensive so never went with it. Also, why would their rep show you a competing products? I've personally never had that happen

 

[Orin]

Business deal resiniferatoxin (RTX)

Since the acquisition of the global rights to RTX back in 2021 we have started the clinical phase III programme with the support of NovaQuest and entered into a licensing agreement with Shionogi.

www.grunenthal.com

Resiniferatoxin: Nature’s Precision Medicine to Silence TRPV1-Positive Afferents - PMC

Resiniferatoxin (RTX) is an ultrapotent capsaicin analog with a unique spectrum of pharmacological actions. The therapeutic window of RTX is broad, allowing for the full desensitization of pain perception and neurogenic inflammation without causing ...

pmc.ncbi.nlm.nih.gov

It has been coming forever, but eventually it'll get here.

Epidural injection is fine and has been done for cancer pain, so not bothered by a little spill over.
Pricing might be an issue.

No motor issues so 'multifidus sparing' and you can use it on the cluneals too if you want!

 

[Orin]

I liked Trident but found it to expensive so never went with it. Also, why would their rep show you a competing products? I've personally never had that happen

Trident was from Diros which was licensed by Avanos to use in the states. It's part of their bag. It may cannibalize their Coolief volume but it is priced for an ASC
Nimbus is the stand-alone competitor which is more like a slight upgrade on Venom/Sidekick

 

[nvrsumr]

If Rfs go away so does my practice. On the other hand never found capsaicin great but haven’t used in many years

 

[Orin]

If Rfs go away so does my practice. On the other hand never found capsaicin great but haven’t used in many years

The CPT code is for "Destruction by neurolytic agent" so I'm not expecting it to go away. I expect though if we're lucky, we may not have to do it with thermal or ultrasound energy, do sensorimotor testing, etc, but we'll see how it does with the peripheral joints as they were late in the clinical trials there

 

[clubdeac]

If Rfs go away so does my practice. On the other hand never found capsaicin great but haven’t used in many years

If RFAs go away so does your practice? I can probably do 2, two level TFESIs in the same amount of time it takes to do a good 3 level unilateral lumbar RF. Take away RF and I just do TFESIs, ILESIs and PNS. I guess mbb's would be gone too. Ahhh you're right, that'll be sad

 

[nvrsumr]

For my payor mix would be a big hit. I also don’t have an inexhaustible supply of patients and repeat rf patients are the steady backbone of my practices financial success.

I see your point and if I was asc owner with unlimited patients I’d just do 12 ilesi/hour

When I was interviewing for a fellowship in Florida they did caudals with Mac at about that clip endlessly

 

[BobBarker]

Yes, if mbb/rf goes away it would have a huge impact on the profitability of my practice.

 

[po_boy]

I thought the only people still using Coolief were CRNAs. Are you a physician?

Interesting post.

 

[po_boy]

Coolief doesn't make sense financially outside of the hospital.

I've been using Tridents for a while now and I like them. Approach is more direct and I place it on the bone at the junction of the TP and SAP. I don't walk off. Good results. Very fast.

Are you only using Trident?

 

[Ferrismonk]

Are you only using Trident?

For thoracic/lumbar yes. Neck I use standard needles.