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Cooled Radiofrequency ablation (RFA) of the sacroiliac joint is a procedure used to alleviate pain originating from the sacroiliac joint by disrupting the nerves that transmit pain signals from the joint to the brain. Here's how the procedure is typically performed:
Similar to other interventional pain procedures, the process begins with a comprehensive evaluation of the patient's medical history, symptoms, physical examination, and any relevant imaging studies.
We discuss the RFA procedure with the patient, including its purpose, potential benefits, risks, and alternatives. Informed consent is obtained from the patient before proceeding.
The patient is prepared for the procedure, which may involve fasting (if sedation is used), changing into a hospital gown, and positioning on the examination table. The area of the sacroiliac joint to be treated is identified and marked.
Local anesthesia is typically used to numb the skin and underlying tissues near the sacroiliac joint. Sedation may also be administered to help the patient relax during the procedure, although some patients may opt for conscious sedation or even no sedation at all.
Fluoroscopy (real-time X-ray imaging) is used to visualise the sacroiliac joint and surrounding structures, as well as to guide the placement of the RFA needle accurately.
Before performing the RFA, a diagnostic nerve block (also known as a medial branch block) is often performed. This involves injecting a local anesthetic near the nerves that supply sensation to the sacroiliac joint to confirm that these nerves are the source of the patient's pain.
Once the target nerves are identified and confirmed, a special needle with an electrode at its tip is inserted near the nerves under fluoroscopic guidance. The electrode emits radiofrequency energy, which creates heat and disrupts the function of the nerves responsible for transmitting pain signals from the sacroiliac joint.
After the RFA procedure is completed, the patient is monitored for a short period to observe for any immediate complications, such as bleeding, infection, or allergic reactions. Vital signs may be checked, and the patient's pain level is assessed.
The patient is provided with instructions for post-procedure care, which may include avoiding strenuous activities for a period of time, applying ice to the treated area to reduce swelling and discomfort, and taking any prescribed medications as directed.
A follow-up appointment is scheduled to evaluate the effectiveness of the RFA procedure and the patient's response to treatment. Further treatment plans, including additional RFA procedures or alternative therapies, may be discussed based on the patient's progress.
Throughout the procedure, we prioritise patient safety, accuracy in needle placement, and effective pain management. Close attention is paid to minimising discomfort and complications while maximising the potential benefits of the cervical facet block for the patient.
Department of Pain Medicine and Palliative Care, Artemis Hospital, sector 51, Gururam 122001 IN