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      Morphologic Analysis of Water-Cooled Bipolar Radiofrequency lesions on Egg White in Vitro

      research-article
      , MD, , MD, , MD, , MD
      The Korean Journal of Pain
      The Korean Pain Society
      bipolar, egg white, radiofrequency

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          Abstract

          Background

          The aim of this study was to document the optimal spacing of two cannulae to form continuous strip lesions and maximal surface area by using water-cooled bipolar radiofrequency technology.

          Methods

          Two water-cooled needle probes (15 cm length, 18-gauge probe with 6 mm electrode tip) were placed in a parallel position 10, 20, 24, 26, and 28 mm apart and submerged in egg white. Temperatures of the probes were raised from 35℃ to 90℃ and the progress of lesion formation was photographed every 1 minute with the increase of the tip temperature. Approximately 30 photographs were taken. The resultant surface areas of the lesions were measured with the digital image program.

          Results

          Continuous strip lesions were formed when the cannulae were spaced 24 mm or less apart; monopolar lesions around each cannula resulted if they were spaced more than 26 mm apart. Maximal surface areas through the formation of continuous strip lesion were 221 mm 2, 375 mm 2, and 476 mm 2 in 10, 20, and 24 mm, respectively. Summations of maximal surface area of each monopolar lesions were 394 mm 2 and 103 mm 2 in 26 and 28 mm, respectively.

          Conclusions

          Water-cooled bipolar Radiofrequency technology creates continuous "strip" lesions proportional in size to the distance between the probes till the distance between cannulae is 24 mm or less. Spacing the cannulae 24 mm apart and treating about 80℃ for 24 minutes maximizes the surface area of the lesion.

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          Most cited references19

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          A cooled needle electrode for radiofrequency tissue ablation: thermodynamic aspects of improved performance compared with conventional needle design.

          I developed and tested a cooled needle electrode (CNE) for radiofrequency (RF) tissue ablation in vitro. A 2-mm needle electrode with two lumina for internal water perfusion and irrigation of the needle tip and a conventional needle electrode were tested in ex vivo calf liver during different levels of output power (wattage). RF lesions produced by the two needle types were further evaluated with a thermal camera. When the CNE was used, a significant increase in the duration of ablation was observed, which caused a significant increase in delivered energy and lesion size when compared with the conventional needle electrode. The largest lesion produced with the CNE was almost spherical and measured 41 x 37 mm (longitudinal x transverse). The cooling effect was reflected in the image obtained with the thermal camera. This technique produced very large lesions compared with conventional methods and may have a role in many different kinds of RF needle ablation.
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            Radiofrequency sacroiliac joint denervation for sacroiliac syndrome.

            Radiofrequency (RF) denervation of the sacroiliac (SI) joint has been advocated for the treatment of sacroiliac syndrome, yet no clinical studies or case series support its use. We report the results of a consecutive series of 50 SI joint RF denervations performed in 33 patients with sacroiliac syndrome. All patients underwent diagnostic SI joint injections with local anesthetic before denervation. Changes in visual analog pain scores (VAS), pain diagrams, physical examination (palpation tenderness over the joint, myofascial trigger points overlying the joint, SI joint pain provocation tests, and range of motion of the lumbar spine), and opioid use were assessed pre- and postdenervation. The criteria for successful RF denervation were at least a 50% decrease in VAS for a period of at least 6 months; 36.4% of patients (12 of 33) met these criteria. Failure of denervation correlated with the presence of disability determination and pain on lateral flexion to the affected side. The average duration of pain relief was 12.0 +/- 1.2 months in responders versus 0.9 +/- 0.2 months in nonresponders (P < or = 0.0001). A positive response was associated with an atraumatic inciting event. Successful denervation was associated with a change in the pain diagram and a reduction in the pattern of referred pain, a normalization of SI joint pain provocation tests, and a reduction in the use of opioids. This study suggests that RF denervation of the SI joint can significantly reduce pain in selected patients with sacroiliac syndrome for a protracted time period. Moreover, certain abnormal physical findings (i.e., SI joint pain provocation tests) revert to normal for the duration of the analgesia.
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              Morphologic analysis of bipolar radiofrequency lesions: implications for treatment of the sacroiliac joint.

              Sacroiliac (SI) joint dysfunction is an important cause of mechanical low-back pain. Bipolar radiofrequency ablation has been proposed as a long-lasting treatment for pain in patients with SI dysfunction who report temporary pain relief with local-anesthetic injection into the joint. No data are available to guide the technical aspects of bipolar radiofrequency lesion creation. This study documents the optimal spacing of cannulae and time required to produce bipolar lesions by use of radiofrequency technology. Two radiofrequency cannulae were secured in a parallel position 2, 4, 6, 8, and 10 mm apart and submerged in egg white for lesion production in a medium that would allow visualization of the size and shape of the lesions as they were created. Temperatures of the probes were raised from 40 degrees C to 90 degrees C at a constant rate and were held at 90 degrees C for 190 seconds. The progress of lesion formation was photographed every 10 seconds, and the resultant surface area of the lesions was measured from the digital images. Contiguous strip lesions were produced when the cannulae were spaced 6 mm or less apart; unipolar lesions around each cannula resulted if they were spaced more than 6 mm apart. Ninety percent of the final lesion area was reached by 120 seconds, and the final lesion size was reached by 150 seconds, regardless of spacing. Bipolar radiofrequency treatment creates continuous "strip" lesions proportional in size to the distance between the probes when the distance between cannulae is 6 mm or less. Spacing the cannulae 4 to 6 mm apart and treating at 90 degrees C for 120 to 150 seconds maximizes the surface area of the lesion.
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                Author and article information

                Journal
                Korean J Pain
                Korean J Pain
                KJP
                The Korean Journal of Pain
                The Korean Pain Society
                2005-9159
                2093-0569
                July 2012
                28 June 2012
                : 25
                : 3
                : 151-154
                Affiliations
                Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
                Author notes
                Correspondence to: Keun Man Shin, MD. Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 445, Gil-dong, Gangdong-gu, Seoul 134-701, Korea. Tel: +82-2-2224-2209, Fax: +82-2-474-0956, kmshin1@ 123456yahoo.co.kr
                Article
                10.3344/kjp.2012.25.3.151
                3389318
                22787544
                24a59934-77f7-4904-a008-227c808f24e4
                Copyright © The Korean Pain Society, 2012

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 15 March 2012
                : 02 May 2012
                : 05 June 2012
                Categories
                Original Article

                Anesthesiology & Pain management
                egg white,radiofrequency,bipolar
                Anesthesiology & Pain management
                egg white, radiofrequency, bipolar

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