What is your RF protocol?

[lobelsteve]

---

Members do not see this ad.

1 joint b/l, 3 joints unilateral, 2 joints tough call.
Burning at 90.

 

[Ducttape]

Anyone burning at 90 or 95 deg C?

I did... too much discomfort even with over cc of 1%. did not notice any significant change in results. I don't think ive ever had to stop with 80 degrees, but Ive had to stop (due to pain) with 90.

and papa lou, to patients, I tell patients that they have to be lying flat on their stomach for 45-50 minutes (takes me ~25 min for 2 levels) or so for bilateral procedure. I sometimes mention it might make their legs a little weak post-procedure, so it is best to have only one side feel weak.

no patients have complained.

 

[Ligament]

I burn at 85 and 90. I suggest you use 4% lidocaine. You will not have any complaints of pain after that. Works fantastic.

 

[DOctorJay]

90 deg for 90 seconds, 2% lidocaine to numb and I like to see a twitch but will burn without it if I like placement
90 degree turn like bedrock prior to second burn

I'm using SIS protocol for placement (and have had to start using a lot more 150 mm probes as a result)

 

[pastafan]

SIS instructors have uniformly been dismissive of 90 degree turn and second burn when I asked about this technique.

Second burn should overlap and be higher/lower on SAP/TP junction depending on positioning of first burn. I have asked at least half a dozen senior instructors and they recommended slight withdrawal and then positioning to ideal position.

Comments?

 

[Aether2000]

The turn and burn seems reasonable given the curve of the tip of the needle. If you want to really expand the burn into a triangle rather than a football, place a second needle on the SAP more superiorly with a more horizontal approach rather than the 15 deg declination. The second needle tip (not an active needle- it is passive and you can leave the stylette in place) is advanced on the SAP until the tip touches the first needle. RF produces a large triangular shaped burn between the unsheathed parts of the two needles. I did this on beef liver to prove it....it works! The SIS board of directors tells the SIS instructors to teach only what is in the Guidelines, and no other techniques. Their instructors have many techniques they use that are permutations on the standard fare, and some are quite impressive. SIS wants them discussed over beer rather than in the lab.

 

[Ligament]

SIS instructors have uniformly been dismissive of 90 degree turn and second burn when I asked about this technique.

Second burn should overlap and be higher/lower on SAP/TP junction depending on positioning of first burn. I have asked at least half a dozen senior instructors and they recommended slight withdrawal and then positioning to ideal position.

Comments?

This is better and what I used to do with smaller gauge RF cannulae. I no longer do that since using 16 ga. Yes, it would be better but I don't think worth the time investment given the outcomes I already get. Most of the guys advocating for the second burn up the SAP are using small gauge RF cannulae. Call me lazy I guess.

 

[Ferrismonk]

Where I am a fellow we do bilateral blocks/RF all the time. To me, unilateral seems more strange honestly. Granted, I'm still a fellow so my experience in limited.

Also, can someone help me find the SIS guidelines that refer to the sensory testing in radiofrequency? Where I am currently training we test both sensory and motor prior to RF, but now that I'm looking at jobs I'm noticing a lot of people skip the sensory step. This would certainly speed up the procedure dramatically. When I look in my books, they tend to say to test for sensory first. I'd like to see the guidelines that were mentioned above.

Thanks.

 

[willabeast]

Where I am a fellow we do bilateral blocks/RF all the time. To me, unilateral seems more strange honestly. Granted, I'm still a fellow so my experience in limited.

Also, can someone help me find the SIS guidelines that refer to the sensory testing in radiofrequency? Where I am currently training we test both sensory and motor prior to RF, but now that I'm looking at jobs I'm noticing a lot of people skip the sensory step. This would certainly speed up the procedure dramatically. When I look in my books, they tend to say to test for sensory first. I'd like to see the guidelines that were mentioned above.

Thanks.

if it was me getting the RF done on myself i would want the least number of nerves burned that gave me a good result. especially if i was paying out of pocket for the procedure. OTOH if i was getting paid more for doing bilateral RF and Dx procedures on people with insurance i would want to burn as many nerves as i could get paid for. a sad state of affairs IMHO. BTW i was trained the same way u were - to always do bilateral Dx blocks. they are often not needed. look at the MRI, see which facets look worse, or if you cannot read MRI's block the side that hurts worse first. remember you are probably taking out some innervation of muscles that help support the same facets that are hurting. regarding skipping the sensory that is fine once you get good - which takes 10,000 hours of doing these. (figure 7 years for most people).

 

[dc2md]

It's a 15-25 minute procedure boss, nobody said it's difficult. You just shouldn't go doing things you don't think about and try to perfect. I'm sure SIS spent a respectable amount of time coming up with best practice guidelines.

On another note, how do you guys explain or rationalize staging the RFA into unilateral procedures? If it's one paravertebral facet level I have always done bilateral but for 2 facets which is what I regularly do, I stage to right side then left side a couple of weeks later. I don't have a good rationalization for patients other than: it takes a long while to do bilateral multilevel RFA. Saying it's "too much local otherwise" as they did in my fellowship seems like an obvious fib. So does saying "it may be too painful" or "that's how I trained."

What do you guys say?

I say "insurance doesn't allow me to kill the pain from more than 3 joints on a single day and if I did both sides I'd be killing the pain from 4 joints, so we'll just have to split it up". Or something like that.

 

[ampaphb]

Where I am a fellow we do bilateral blocks/RF all the time. To me, unilateral seems more strange honestly. Granted, I'm still a fellow so my experience in limited.

Also, can someone help me find the SIS guidelines that refer to the sensory testing in radiofrequency? Where I am currently training we test both sensory and motor prior to RF, but now that I'm looking at jobs I'm noticing a lot of people skip the sensory step. This would certainly speed up the procedure dramatically. When I look in my books, they tend to say to test for sensory first. I'd like to see the guidelines that were mentioned above.

Thanks.

I emailed Dr. Dreyfuss, asking him his protocol. He.does not check impedance. He does not do sensory or motor testing.

Sent from my SAMSUNG-SM-G920A using SDN mobile