Procedure: Rt RFA of median branch nerve at level of thoracic level T6,T7 and T8 to block the facet joint at the level of thoracic facet T7-8 and T8-9.

Procedure details: Fluoroscopy was used to identify the bony landmarks of the spine and the planned needle approach. The skin, subcutaneous tissue and muscle within the planned approach were anesthetized with 1% lidocaine. With Fluoro a 22 G 10-mm active tip needle was gently guided into the region of the medial branch nerves from the dorsal ramus of the above levels at the right T6,T7 and T8 to block the facet joint of T7-8 and T8-9 and the right side. Specifically each needle tip was inserted to the superior and lateral border of the transverse process. Needle localization was confirmed with AP, scotty dog views and lateral radiographs.

The following technique was used to confirm placement at the medical branch nerves. Sensory stimulation was applied to each level at 50Hz; parathesias was noted below 0.6 millivolts. Motor stimulation was applied at 2Hz with 1 millisecond duration; corresponding paraspinal muscle twitching without extremity movement was noted.

Following this, the needle trocar was removed and a syringe containing 0.25% bupivacaine was attached. At each level, after syringe aspiration with no blood return, 1mL 0.25% bupivacaine was injected to anesthetize the medial branch nerve and surrounding tissue. After completion of each nerve block a lesion was created at that level with a temperature of 80 degrees Celsius for 90 seconds.

Thanks for any insight into this.