Reasons I like RFA similar to Dr Buchan-
* CT is quick and no claustrophobia
* One can easily find nerves and target perineural space as compared to bony landmarks pain interventionists use in flouro
* RFA is 22G- v small probe compared to cryo-I like it for all small nerves. It can be used on any nerve deep in pelvis with 5mm radius of ablation. We have had zero complications till now after ablations of pudendal, iliohypogastric, LFCN, ilioinguinal, medial branch rhizotomy, etc.
* Responses of ablation are much more prolonged than simple injections.
Avneesh Chhabra, M.D. M.B.A.
Professor Radiology & Orthopedic Surgery
Chief, Division of Musculoskeletal Radiology
UT Southwestern Medical Center, Dallas, Tx
5373 Harry Hines Blvd.
Dallas, Tx-75390-9178
Office: 214-648-2122
avneesh.chhabra@utsouthwestern.edu<mailto:avneesh.chhabra@utsouthwestern.edu>
www.utsouthwestern.edu<www.utsouthwestern.edu/>
We don’t at University Wisconsin.
When I was at MCW I would do some of the genicular blocks for our IR guys who would do the ablation. We used fluoro. I’m curious why you use CT for this.
John
________________________________
From: Craig Buchan <cbuchan@sydney.edu.au>
Sent: Tuesday, February 22, 2022 6:14 PM
To: Avneesh Chhabra <Avneesh.Chhabra@UTSouthwestern.edu>
Subject: Re: Interventional topic
EXTERNAL MAIL
Hi Avneesh,
I work in a large public and private practice on the Gold Coast in Queensland, Australia. I have met you briefly before at SSR. I have been doing geniculate nerve RFA for about 7 years, probably done over 300 patients now. I also enjoy this procedure with overall good results.
I target 3 nerves (SMGN, SLGN, IMGN), rarely do infrapatellar branch saphenous nerve (IBSN) (if PF pain). Best patients seem to be KL 2-3 medial compartment OA, trying to avoid surgery or not for surgery. Have done quite a few post painful TKR. I have tried US and CT, like you I prefer CT. Quick and easy on CT, low risk of complication. I do thermal RFA, 80deg C for 80 secs. Always do pain block 2 weeks before with celestone/0.5% Marcain to assess response. If I don’t do this there is risk of neuropathic pain post procedure.
Do you target any other nerves (eg. nerve to vastus intermedius) as per Pain literature? Do you ever do cryoablation for these – I would love to try it but don’t have cryo machine? I have extensive experience also with RFA suprascapular nerve (usually pulsed), morton’s neuroma (thermal) and an extensive practice doing lumbar medial branch and SIJ RFA.
I am keen to learn your parameters. If you would like to collaborate on research in this area let me know.
Regards,
Dr. Craig Buchan BCom MBBS (Hons) FRANZCR MMed (Pain Mgmt)
MRI Specialist and Musculoskeletal Interventional Radiologist
(PH): +61 413 533 126
________________________________
From: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com> on behalf of Avneesh Chhabra <Avneesh.Chhabra@UTSouthwestern.edu>
Sent: Wednesday, February 23, 2022 4:27 AM
To: ocad-msk@googlegroups.com <ocad-msk@googlegroups.com>
Subject: Interventional topic
How many of y’all do joint ablations- genicular nerves in this case with RF ablation
we are getting great results- it’s kind of fun too!
see attached!
Best!
AC
Avneesh Chhabra, M.D. M.B.A.
Professor, Radiology & Orthopedic Surgery
Chief, Musculoskeletal Radiology
Department of Radiology
5323 Harry Hines, Blvd. Dallas, Tx-75390-9316
Office: 214-648-2122
www.utsouthwestern.edu/radiology<protect-au.mimecast.com/s/2F4cCzvkyVCMlqz4Ah4q8NM?domain=utsouthwestern.edu/>
________________________________
UT Southwestern
Medical Center
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