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Dr Hitesh Patel is Consultant – Pain Management & Palliative Care he recieved his M.D. from B.J. Medical College Ahmedabad, Asia’s largest hospital, Civil Hospital, Ahmedabad. He earned his F.I.P.M. (Fellow In Pain Management) at Daradia Pain Hospital in Kolkata, which is affiliated with the Aesculap Academy in Germany. He received his C.C.P.P.M. (Certificate Course in Pain and Palliative Medicine) from Gujarat Cancer Research Institute Ahmedabad, the state’s largest cancer hospital.

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What is radio frequency ?

Radiofrequency is a procedure in which a high-frequency current of 300-500 kHz is used to lesions on a particular target site. This high-frequency current is similar to that used in radio transmitters so that it is called Radiofrequency. It is very useful nowadays in pain medicine due to the increase in research and precision in locating the pain generator.

Types of Radiofrequency

  • Conventional Radiofrequency
  • Pulsed Radiofrequency
  • Cooled Radiofrequency
RF lesion

Uses of Radiofrequency

  • TRIGEMINAL BLOCK- for Trigeminal Neuralgia
  • T2-T3 Sympathetic block – for CRPS of the upper limb, atypical facial pain, post-mastectomy pain and swelling, frostbite of the upper limb, post upper limb amputation pain
  • COELIAC PLEXUS BLOCK -MALIGNANCY OF stomach, liver, spleen, pancreas, kidney and GI tract up to splenic flexure, Chronic pancreatitis
  • LUMBAR SYMPATHETIC BLOCK- for CRPS I AND II,Neuropathic pain, Lower Extremity vascular insufficiency, Painful diabetic neuropathy
  • GANGLION IMPAR BLOCK- for Malignant perianal pain, Visceral pain
  • SUPERIOR HYPOGASTRIC BLOCK- for cancer bladder, urethra, uterus, vagina, vulva, perineum, prostate, penis, testes, rectum, and descending colon, Endometriosis, PID
  • Recurrent Facet Joint arthropathy– – a common cause of back pain
  • Recurrent Sacroiliac Joint arthropathy
  • Osteoarthritis Knee – genicular branch block for knee pain

Process of Radiofrequency

Drug Therapies

Radiofrequency is little bit painful procedure as we need to check for sensory and motor stimulation so we cannot give Local anesthetic. In this technique Voltage generator is attach between the active tip of Radiofrequency needle and the ground plate with the body tissue in between to make it close circuit. After that we first check the Sensory stimulation by setting 50 Hz current and check for the same kind of pain patient feels in particular area that patient have pain. After the sensory stimulation we start to check for the Motor stimulation at 5 Hz and the check for the voltage of the current. In pain generator near to spine or need to Radiofrequency of sensory fiber of nerve root we check for Sensory Motor Dissociation. In that we check for sensory component and check the current voltage for it and after that we go for motor stimulation and go for double the current required than sensory stimulation.

Duration of action

Duration of action is 2-4 years in case of Conventional Radiofrequency and 4-24 months in case of Pulsed Radiofrequency.

Mechanism Of Action Of Radiofrequency

Conventional Radiofrequency: In conventional Radiofrequency Thermal ablation is the main action. we can set the temperature at a different level and also we can set the time required to continue the procedure. Depending on the pain generator time varies according to the procedure. In conventional Radiofrequency heat is generated that creates the lesion around the nerve and ablates the signals that covey by it. In this 2-4 mm of the lesion is created, 2 mm at shaft and 4 mm tip. here temperature goes beyond 60 degrees Celsius so we give LA before the procedure to decrease the pain.

Pulsed Radiofrequency: Here the main mechanism is the generation of an Electromagnetic field that stimulates the oncogenes and anti-inflammatory components that is helpful, particularly in joint space. It also stops the nociceptive signals from the nerves also. Here the maximum temperature is 42 degrees Celsius and the minimum duration is 180 seconds which does not produce heat like conventional Radiofrequency so it is not that much pain. here also 2-4 mm lesion is generated.

Cooled Radiofrequency: In this type there are two different electrodes of which one acts as heat generator and the other act to cool.