Serenity

What is a genicular nerve radiofrequency ablation (RFA) or Rhizotomy?
A genicular nerve RFA is a procedure to cauterize (burn) a nerve that is transmitting pain signals from an arthritic or damaged knee to the brain.

What is the purpose of a genicular nerve RFA?
There are a series of nerves that transmits pain from a knee to the brain when the knee is arthritic or damaged. If these nerves are ablated (or cauterized), pain from the knee can no longer be transmitted to the brain. A genicular nerve RFA is therefore performed to alleviate pain due to arthritic or damaged knees, and this treatment typically works for 6-12 months. Pain recurs as those nerves regenerate.

How is the procedure performed?
You will be placed on the procedure table. The injection site is sterilized with either iodine or chlorhexadine. The site to be injected is numbed with a local anesthetic, and a needle is directed to the target area. X-ray guidance is used to ensure proper placement and positioning of the needle. Once the needle is properly positioned, a test is performed to ensure the needle tip is close to the appropriate nerve, and that it is close enough to ensure a successful ablation. Radiofrequency waves are then transmitted to the tip of the needle, which causes it to reach a temperature of 80 degrees Celsius. The needle tip is heated to this level for sixty seconds in order to complete the ablation process. This process is repeated for each targeted nerve.
 

Will the procedure be painful?
The injection can be painful and we therefore provide the option of receiving an oral pre-medication. Oral pre-medication, combined with local anesthetic, can make the procedure more tolerable. If you decide to have a pre-medication, you must have a driver to get you home safely afterwards.

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What are the discharge instructions?
Rest for at least a few hours following the procedure and apply ice as directed to the procedure sites. If you received a pre-medication, do not drive or operate machinery for at least 12 hours after the procedure. You may return to work the next day following your procedure. You may resume your normal diet immediately. Do not engage in any strenuous activity for 24 hours. Do not take a bath, swim, or use a hot tub for 24 hours (you may take a shower). Call the office if you have any of the following: severe pain afterwards (different than your usual symptoms), redness/ swelling/ discharge at the injection site(s), fever/chills, difficulty with bowel or bladder functions.
 

What are the risks and side effects?
The complication rate for this procedure is very low. Whenever a needle enters the skin, bleeding or infection can occur. Some other serious but extremely rare risks include paralysis and death.
You may have an allergic reaction to any of the medications used. If you have a known allergy to any medications, especially x-ray contrast dye or local anesthetics, notify our staff before the procedure takes place.

You may experience any of the following side effects up to 4 hours after the procedure:
● Leg muscle weakness or numbness may occur due to the local anesthetic affecting the nerves that control your leg (this is a temporary affect and it is not paralysis). Your leg strength will return slowly and completely.
● Dizziness may occur due to a decrease in your blood pressure. If this occurs, remain in a seated or lying position. Gradually sit up, and then stand after at least 10 minutes of sitting.
● Mild headaches may occur. Drink fluids and take pain medications if needed. If the headaches persist or become severe, call the office.
● Mild discomfort at the injection site can occur. This typically lasts for a few hours but can persist for a couple days. If this occurs, take anti-inflammatories or pain medications, apply ice to the area the day of the procedure. If it persists, apply moist heat in the day(s) following.
 

The side effects listed above can be normal. They are not dangerous and will resolve on their own. If, however, you experience any of the following, a complication may have occurred and you should either contact your doctor. If he is not readily available, then you should proceed to the closest urgent care center for evaluation:
● Severe or progressive pain at the injection site(s)
● Arm or leg weakness that progressively worsens or persists for longer than 8 hours
● Severe or progressive redness, swelling, or discharge from the injections site(s)
● Fevers, chills, nausea, or vomiting

● Bowel or bladder dysfunction (i.e. inability to urinate or pass stool or difficulty controlling either)
 

How long does it take for the procedure to work?
The healing process can take up to 2-4 weeks. As your nerve(s) heal from this procedure, the pain will continue to improve. The maximum benefit from this procedure is typically experienced about 2 weeks afterwards, and this typically lasts 6-12 months.