Basics of radio frequency techniques in pain management jadon.a

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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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Basics of radio frequency techniques in pain management jadon.a

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

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