i hope before you have a rhizotomy, you had facet joint injections done to ensure the facet joint is your pain generator. we do rhizotomies two different ways. one is with a radio frequency machine and one is done chemically with phenol. a simple explanation is that both destroy the nerve, which in time regenerates. we do cervical, thoracic, lumbar, and sacral facet rhizotomies with good results. our patients get anywhere from a couple of months to over a year of good pain relief. we do not usually sedate our patients during this procedure but we do give them iv fentanyl to help with the discomfort. if you have any questions i would be glad to answer what i can.
I've had facet blocks, epidurals, and most recently another facet injection to ensure the cause of pain. What I'm most concerned about is the sensation when the nerve is "burned". Is this a jolt that sends patients screaming or more of a tingling sensation?
If the rhizotomy is done by radio frequency there is a ultra thin wire that goes through a special needle. After careful placement and testing done to check the impedence and to ensure no muscle involvement, the wire is removed and lidocaine is injected to numb the nerve, then the wire replaced and is heated via the "RF" machince and the lesion takes place. There should be no jolt or tingling sensations, some have said they feel a warm sensation but not burning. There are several ways the "RF" can be done, bi-polar, pulse and the continous current. If the rhizotomy is done with phenol (chemically) it is just an injection into the facet joint and pressure and/or discomfort could be felt around the nerve do to the volume of medication injected. We give IV fentanyl for pain control and most 85-90% tolerate the procedure without any problems and a few even request "RF's" when they come because of the amount of relieve they get. Hopefully that helps some, it is a common procedure here and a safe one. If you have any other questions I would try to answer them. Mags
Thanks for the good info maggiernpainnurse!!! Unfortunately, my procedure was postphoned 2 weeks as I developed a big 2X8 hematoma on my right flank area, have been taking aspirin, so I am looking forward to some pain relief. My facet joints in a couple of areas are bone on bone and have bulging discs in my lumbar spine. Also need attention to cervical and thorasic areas as well.I am glad to hear there is no real pain involved. I have had no previous pain control other than Rx. They are going on my symptoms! So, my insurance may want them to start out with injections who knows, but I have done alot of reading on this and it seems to be just what I need. I have ankylosing spondylitis and Ra and have more pain than I am willing to admit, just think I got used to it!!!!
Again, thanks for taking the time to reassure a fellow nurse. You are in a wonderful growing field and know you must be a very compassionate and knowledgable RN. We need lots of em!!!!!!
Thanks for the up date, keep me informed. This is a great area to work in, most of the time. We do have our challenges, but my job is very rewarding. If you have any concerns or question don't hesitate to ask. I have a great doctor that I work with and he is a unbelievable source for information. Mags
i work in a pain clinic in southwest missouri at a small hospital; we are a complete pain management clinic, doing both procedures and long term narcotic management. i have work in pain management for over 10 years and now work with one anesthesiologist who is great. at one time he was in a group with eight partners at a big hospital and as staff we had to know their preferences, which could be confusing when you could have up to three different providers in a week. :uhoh21: here in the town i work at there are three hospital based clinics and multiple pcp's who do some form of steroid therapy. it is amazing how much difference there is in clinics, some will not give sedation with procedures, post procedure pain meds or do long term medical management. since we do it all, the practice is full and takes very few new patients, which is sad because we have to turn down so many referrals , (we are a small facility and my doc can only see so many people in a day). hopefully that helps a little, if there is something more specific you would like to know just let me know and i will try and help you.
I had it done and it made no difference. The doctor said he wants to try the two nerves just below but needs to wait 6 weeks. In the meantime, back to the Darvocet!
I am curious how many and what nerves did he do did the rhizotomy on. Also when you had your last facet joint injection did he use steroids or just lidocaine? If steroids were used it could have given false impression of a pain generator was found by giving relief in that area from the steroids. I am so sorry it didn't work for you, our patients get great relief from them. But as Kally said they have to make sure the facet joint is the pain generator.