Basics of radio frequency techniques in pain management  jadon.a
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Basics of radio-frequency ablation techniques...

Basics of radio-frequency ablation techniques

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  • Dr. Jadon. I am a Pain Medicine physician in the United States. Is it possible to train with you for 2-4 weeks in advanced RFA techniques? nels.dahlgren@gmail.com
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  • 1. Basics of Radio Frequency techniques in Pain Management Dr. Ashok Jadon, MD DNB Sr. Consultant & HOD Anaesthesia Tata Motors Hospital, Jamshedpur
  • 2. Principle of RF lesion
    • RF lessoning involves passage of a very high frequency current (at 300 kHz) through a 27 G thermocouple probe.
    • When a high frequency alternating current is passed
      • To & fro movements of the charged ions
      • Generation of heat due to this electro-mechanical friction.
  • 3. stylet Exposed tip = 5 mm RF electrode
  • 4.  
  • 5. Principle of RF (contd.)
    • The electrical field generation and movement of charged particle is maximum at its tip and minimum around the shaft.
    • Therefore the heat lesion is maximum around the shaft and minimum at its tip.
  • 6. Conventional vs. Pulsed RF
    • Heat producing lesion.
    • Temp can go up-to 85 degree C.
    • In the pulsed RF electrical field is producing the lesion.
    • Temp. is not raised beyond 42 degree C
    In pulsed RF. Electrical field produces some punch in the capacitor of small diameter nociceptive fibers. Thereby signal transmission is stopped.
  • 7. Conventional vs. Pulsed RF
    • In the conventional type the nerves are regenerated in future.
    • Average pain-free period varies for type of nerve. (3-4) years.
    • In the pulsed RF the nerve is repaired.
    • Average pain free period is 4-24 months.
  • 8. Lesion characteristics
    • Temperature
    • Rate of thermal equilibrium
    • Local Tissue characteristics-Impedance
    • Radius of Electrode tip and Configuration
  • 9. Impedance
    • Proximity of electrode to the CSF can present low impedance pathway
    • Proximity of large blood vessel to electrode can deviate the energy
    • Proximity to bone can cause discontinuity of heat due to lower conductivity
  • 10. Lesion size versus Lesion Time CW: 20V, t= 0 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 11. CW: 20V, t=10 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 12. CW: 20V, t=20 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 13. CW: 20V, t=30 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 14. CW: 20V, t=40 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 15. CW: 20V, t=50 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 16. CW: 20V, t=60 sec COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 17. CW: 20V, t=60 sec 50˚C Isotherm |E|=2,750 V/m |E|=17,000 V/m COSMAN, MIT 37˚C 40˚C 45˚C 60˚C 55˚C 50˚C 67˚C
  • 18. Choice Between Conventional RF & Pulsed RF
    • Special Indication
    • Proximity to Vital Structures
    • Newer Research
  • 19. Localization of the Target nerve
    • Fluoroscopic guidance is mandatory
    • Check impedance for the integrity of the circuit (between 200 to 700  )
    • Sensory-Motor Dissociation
      • Sensory stimulation at X
      • No motor stimulation at 2X
  • 20. Conventional RF
    • Sensory testing: 0.4-0.6 V at 50 Hz
    • Motor testing: 1V at 2Hz
    • Lesion is carried at 80 -85 degree C for
    • 60 – 90 sec.
  • 21. Clinical Indications of Conventional RF
    • Gasserian ganglion Trigeminal Neuralgia
  • 22. Indications of Conventional RF Contd… Cervical facet joint denervation Sacro -iliac Joint denervation
  • 23. Conventional RF Contd.. Lumber facet joint denervation
  • 24. Indication of Pulse RF
    • Stellate Ganglion
    • Other Ganglion
    • Brachial Plexopathy
    • Suprascapular
    • AS ROMANS’ DO
    • Knee Neuropathic Pain
    Stellate Ganglion RF
  • 25. Cervical DRG lesioning
  • 26. Lumber DRG lesioning
  • 27. Lumber DRG lesioning
  • 28. Lumber sympathetic block
  • 29. Complications
    • Dysesthesia-5-25%
    • Anesthesia dolorosa
    • Masticator muscle weakness -4%
    • Facial numbness
    • Corneal analgesia-15%
    • Keratitis
    • Chemical meningitis
    • Carotid-cavernous fistula
    • Haematoma –Cheek, Retrobulbar
    • Cerebrospinal fluid leak
    • Cranial nerve paralysis
  • 30. Conclusion
    • Radiofrequency Ablation is a useful minimally invasive option for offering long-term pain relief, improving quality of life in a significant proportion of chronic pain patients.
    • Careful patient selection & thorough knowledge about the proposed procedure are mandatory
  • 31.
    • My Sincere Thanks to
    • Dr Gautam Das
    • Dr Krishna Poddar
  • 32. Thank You