In some patients loss of physical height is the result of such things as disc degeneration or vertebral compression fractures. This loss of height causes the ribs to rub on the top of the hips (iliac crest) and cause direct irritation to the intercostal nerves leading to low back pain ; usually felt wide on the top of the hips (laterally). PRF to the Intercostal nerves is used to stop pain signals from this nerve irritation from reaching the spine allowing them to be transmitted to the brain
INTEERCOSTAL NERVE (ICN) PULSED RADIOFREQUENCY (PRF)
In some patients loss of physical height is the result of such things as disc degeneration or vertebral compression fractures. This loss of height causes the ribs to rub on the top of the hips (iliac crest) and cause direct irritation to the intercostal nerves leading to low back pain ; usually felt wide on the top of the hips (laterally). PRF to the Intercostal nerves is used to stop pain signals from this nerve irritation from reaching the spine allowing them to be transmitted to the brain
Indicators
- Chest wall pain and on some occasions abdominal pain
- Return of l chest wall pain, after past benefit from injection to the site.
When you booking the procedure
On the day of booking your procedure, please advise staff if you are –
- Taking blood thinners (especially warfarin and clopidogrel)
- Diabetic
- Pregnant, or any chance of being pregnant
Allergic to:
- Shellfish
- Steroids
- Local anaesthetics
- Iodine
- Betadine
- Chlorhexidine
- Unwell or have an infection
DAY OF THE PROCEDURE
- DO NOT eat or drink (for 6 hours before your procedure),
- TAKE your usual medications with a small amount of water (apart from those mentioned previously), and
- ARRANGE for someone to accompany you home.
DURING THE PROCEDURE
After arriving you will need to complete the necessary paperwork. Then –
- You will change into a hospital gown,
- A small drip will be inserted into one of your veins,
- You may be given a mild sedative,
- Your heart rate and blood pressure will be monitored throughout the procedure,
- You will lie face down on an x-ray table, then the skin over the area to be injected will be cleaned with an antiseptic solution,
- A sterile barrier will be created,
- A local anaesthetic will be injected to numb the area,
- You will be asked to map out your pain distribution,
- An x-ray machine will be used to guide a small needle towards the nerve,
- You may experience some discomfort, however this usually subsides and can be treated with icepacks and medication.
AFTER THE PROCEDURE
- You will be monitored in a recovery area until you are ready to go home. This usually takes between 60 – 120 minutes.
- You will be given a pain relief chart to fill out. SHOW this to your doctor at your next consultation.
- Preferably, someone will take you home and stay with you for the next 24 hours.
- Pain may return when the anaesthetic wears off. Some people experience an initial increase in pain and stiffness, which may continue for several days. If necessary you may apply an ice pack to the area for 20 minutes at a time, for 1-2 days following the procedure.
- You may take simple pain-killers such as Paracetamol or sometimes opioids to ease any discomfort.
- Remove any dressing the day after your procedure.
- Avoid a rapid increase in your activities. Gradually increase your daily activities as tolerated. Discuss this with your doctor.
If steroids were injected, it may take several days for the benefits to be noticed. Additionally, you may feel flushed in the face and/or notice a change in your mood for a few days. Diabetic patients may notice a rise in blood sugar levels.
If you have received sedation during your procedure, the effects may last up to 24 hours. Due to the effects, you may not remember some of the information given to you during the procedure. For the next 24 hours, you SHOULD NOT –
- Drive a vehicle,
- Drink alcohol,
- Operate machinery,
- Make important decisions,
- Sign legal documents, or
- Travel unaccompanied.
COMPLICATIONS
Common Complications
- Continuing pain / no benefit
- Minor bleeding in the area injected
- Bruising in the area injected
- Temporary weakness or numbness from the local anaesthetic
- Brief increased pain that may fluctuate in intensity
More Serious Side Effects
- Damage to surrounding structures
- Pneumothorax (collapsed Lung)
- Infection
- Permanent nerve injury
- Allergy to the anaesthetic drugs used as part of the procedure
- Increase of any pre-existing medical condition such as cardiac conditions
- Bruising around the area from needle trauma
- Aspiration during sedation
- Eye injury while lying prone (face down)
- Serious anaesthetic / procedural complications and very rarely death
- Increased lifetime risk of cancer due to X-rays exposure
- Very rare risk of surgery due too injuries from the procedure
Please discuss with your doctor any other questions you may have about this procedure or this information sheet. If you agree to have the procedure, you will be asked to sign a consent form.
If you notice –
- Any swelling from the site,
- Any bleeding from the site, or
- Have any other concern
Please contact your General Practitioner, Queensland Pain Clinic, or the Emergency Department of your local hospital.