Radio Frequency Ablation
Radio Frequency Ablation is a pain management procedure our clinic can use to interrupt nerve conduction on a semi-permanent basis. Using a specialized machine, the procedure disrupts nerve conduction (such as conduction of pain signals), and may in turn reduce pain, and other related symptoms. The nerves are usually blocked for 6-9 months (but can be as short as 3 months or as long at 18 months). Approximately 70-80% of patients will get good block of the intended nerve. This should help relieve that part of the pain that the blocked nerve controls. Sometimes after a nerve is blocked, it becomes clear that there is pain from the other areas as well.
How long does the procedure take?
Depending upon the areas to be treated, the procedure can take from about twenty minutes to a couple of hours.
Where is the procedure performed?
The procedure is usually performed in an operating room, sometimes in a fluoroscopy (x-ray) room.
How is it actually performed?
Since nerves cannot be seen on x-ray, the needles are positioned using bony landmarks that indicate where the nerves usually are. Fluoroscopy (x-ray) is used to identify those bony landmarks. A local anesthetic (like Novocaine) is injected to minimize the discomfort. After confirmation of the needle tip position, a special needle tip is inserted.
When the needle is in good position, as confirmed by x-ray, electrical stimulation is done before any lesioning. This stimulation may produce a buzzing or tingling or pressure sensation or may be like hitting your "funny bone". You may also feel your muscles jump. You need to be awake during this part of the procedure so you can report what you’re feeling. The tissues surrounding the needle tip are then heated when electronic current is passed using the Radio Frequency machine, for a few seconds. This "numbs" the nerves semi-permanently.
Will the procedure hurt?
Layers of muscle and soft tissues protect nerves. The procedure involves inserting a needle through skin and those layers of muscle and soft tissues, so there is some discomfort involved. However, we numb the skin and deeper tissues with a local anesthetic using a very thin needle prior to inserting the needle. There is moderate discomfort involved for a few weeks after. You may have numb areas with increased sensitivity (like a deep sun-burn).
Will I be "put out" for this procedure?
No. This procedure is done under local anesthesia. Most of the patients also receive intravenous sedation and analgesia, which makes the procedure easier to tolerate. The amount of sedation given generally depends upon the patient tolerance. It is necessary for you to be awake enough to communicate easily during the procedure.
How is the procedure performed?
It is done either with the patient lying on the stomach when working on the facet joints, low back for lumbar sympathetic nerves, and in sitting position when lesioning the cervical (neck) area. The patients are monitored with EKG, blood pressure cuff, and blood oxygen-monitoring device. The skin on the back is cleaned with antiseptic solution and then the procedure is carried out. X-ray (fluoroscopy) is used to guide the needles.
What should I expect after the procedure and what are the side effects?
Initially there will be muscle soreness for up to a week afterward. Ice packs will usually control this discomfort. After the first two weeks are over, your pain may be gone or quite less. Some patients may have some "deep sun-burn" type feeling. Some may develop hypersensitivity or burning pain or numb areas for a few weeks. After lesioning of the 3rd Occipital nerve (for headaches), some of the patients may develop dizziness or vertigo for a few days. The relief of pain is noticed in about 2 to 3 weeks, not right away.
What should I do after the procedure?
You should have a ride home. We advise the patients to take it easy for a day or so after the procedure. You may want to apply ice to the affected area. Perform the activities as tolerated by you.
Can I go to work to work the next day?
You should be able to return to your work the next day. Sometimes soreness at the injection site causes you to be off work for a day or two.
How long will the effects of the procedure last?
If successful, the effects of the procedure can last from 3-18 months, usually 6-9 months.
How many procedures do I need to have?
If the first procedure does not relieve your symptoms completely, you may be recommended to have a repeat procedure after re-evaluation. Because these are not permanent procedures, they may need to be repeated when the numbness wears off (often 6-12 months).
Will the Radio Frequency Lesioning help me?
It is very difficult to predict if the procedure will indeed help you or not. Generally speaking, the patients who have responded to repeated local anesthetic blocks will have better results.
What are the risks?
Generally speaking, this procedure is safe. However, with any procedure there are risks, side effects, and the possibility of complications. The risks and complications are dependent upon the sites that are lesioned. Any time there is an injection through the skin, there is a risk of infection. This is why sterile conditions are used for these blocks. The needles have to go through skin and soft tissues, which will cause soreness. The nerves to be lesioned may be near blood vessels or other nerves, which can be potentially damaged. Great care is taken when placing the radio frequency needles, but sometimes complications occur. Please discuss your specific concerns with your physician.
Who should not have this procedure?
If you are on a blood thinning medication (e.g. Coumadin®, Plavix®), or if you have an active infection going on, you should not have the procedure. If you have not responded to local anesthetic blocks, you may not be a candidate for this procedure.
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