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      Sequential bipolar radiofrequency lumbar sympathectomy in Raynaud's disease -A case report-

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          Abstract

          A 39-year-old female was suffering from cold-induced Raynaud's attacks in both hands and feet, with symptoms being most severe in her left foot. The patient did not respond to medical treatments and was referred to our department of pain medicine. We performed sequential bipolar radiofrequency lumbar sympathectomy to the patient, which offered a long duration of symptom relief. Sequential bipolar radiofrequency lesions could create continuous strip lesion, and thus, could achieve better results, while the potential risk of liquid neurolytic agents could be avoided.

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          Raynaud's phenomenon: a proposal for classification.

          E C LeRoy, T Medsger (2015)
          Major confusion exists with regard to the definition of patients with Raynaud's phenomenon; defining the patient and the phenomenon are reasonably straightforward, but variations in the definition of its primary and secondary forms have created a situation in which the same patient might be classified as primary by one group and secondary by another. The present essay is a proposal for the strict definition of Primary Raynaud's Phenomenon (PRP) formulated as a hypothesis amenable to experimental testing. This hypothesis is tested retrospectively on a group of 240 patients with Raynaud's phenomenon. The proposed criteria permit classification in 215 of 240 cases or 89%, leaving 25 patients difficult to classify at initial evaluation. Further testing of the hypothesis is encouraged.
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            Radiofrequency sacroiliac joint denervation for sacroiliac syndrome.

            F M Ferrante, L King, E Roche … (2015)
            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.

              Carlos Pino, Mark A Hoeft, Craig Hofsess … (2015)
              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
                Journal ID (nlm-ta): Korean J Anesthesiol
                Journal ID (publisher-id): KJAE
                Title: Korean Journal of Anesthesiology
                Publisher: The Korean Society of Anesthesiologists
                ISSN (Print): 2005-6419
                ISSN (Electronic): 2005-7563
                Publication date (Print): October 2010
                Publication date (Electronic): 21 October 2010
                Volume: 59
                Issue: 4
                Pages: 286-289
                Affiliations
                Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding author: Keun-Man Shin, M.D., Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 445, Gil-dong, Gangdong-gu, Seoul 134-010, Korea. Tel: 82-2-2224-2209, Fax: 82-2-474-0956, kmshin1@ 123456yahoo.co.kr
                Article
                DOI: 10.4097/kjae.2010.59.4.286
                PMC ID: 2966713
                PubMed ID: 21057622
                SO-VID: 96b871d9-0976-4a5a-93ab-23a39dbfbd68
                Copyright © Copyright © The Korean Society of Anesthesiologists, 2010
                License:

                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
                Date received : 05 October 2009
                Date revision received : 30 October 2009
                Date accepted : 26 November 2009
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: radiofrequency,bipolar,raynaud's disease,lumbar sympathectomy
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: radiofrequency, bipolar, raynaud's disease, lumbar sympathectomy

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