Radiofrequency ablation of sympathetic nervous system

Patient Information Leaflet

Introduction

Welcome to The Dudley Group NHS Foundation Trust. This leaflet will provide you and your relatives with information about radiofrequency ablation of sympathetic nervous system. It includes information on what radiofrequency ablation of sympathetic nervous system is, the risks and benefits of it and what the procedure involves.

What is radiofrequency ablation of nerves?

A radiofrequency ablation (RFA) is a treatment that uses radio waves to create heat to destroy a part of specific nerve. These special (sympathetic) nerves carry pain signals from a painful area to the brain. If they are destroyed, it can provide long term relief of neck or back pain without any loss of sensation.

During the procedure, electrical stimulation and sometimes ultrasound are used to locate the correct nerve and then radiofrequency energy is used to disrupt it. You will also be given a local anaesthetic and steroid injection to help relieve short term pain following RFA.

In order for the consultant to be sure that they are targeting the right nerve, RFA is only offered to people who have had two successful diagnostic nerve block procedures.

What are the benefits?

RFA can provide long term relief of neck or back pain without any loss of sensation.

What are the risks?

Overall, the procedure is very safe and serious side effects or complications are rare. However like all injection procedures there are some risks:

Common risks

• Bruise or tenderness at the site of injection.
• An increase for the first few days.
• Drop in blood pressure and a feeling of being lightheaded.
• You may develop temporary weakness in your legs.
• You may have groin pain which should disappear in one to two days.

Rare risks – these will depend on the site of the procedure

• No change in pain levels.
• Bleeding.
• Low blood pressure.
• Infection.
• Erectile dysfunction (inability to get and maintain an erection).
• Temporary urine retention (inability to empty your bladder).
• Collapsed lung.
• Nerve injury which can be temporary or permanent.
• Spinal cord injury.
• Convulsions.
• Allergic reaction.
• Stroke.
• Cardiac arrest.

If you experience any of these rare risks after the procedure, please contact the Pain Management Helpline on 01384 244735, your GP or in an emergency dial 999.

Steroid-related risks

Compared to regular steroid use, the steroid injection used for pain procedures is associated with very few side effects, however:

• If you have diabetes, you may experience a slight rise in blood sugar for up to two weeks so you should monitor your blood sugar very carefully. Contact your GP or diabetic nurse if you have any problem).
• If you have heart failure, you may experience increased shortness of breath due to salt and water retention. Contact your GP or nurse if you have any problems.

X-ray precautions:

• The procedure uses X-rays and these use a small amount of radiation which may add slightly to the normal risk of cancer.

Female patients – you must tell us if you are or might be pregnant. If you are not sure, a pregnancy test will be offered.

What are the alternatives?

You do not have to have RFA treatment and your consultant will discuss alternative treatments with you appropriate to your condition. If you prefer, you can continue to take painkilling medication without having any other treatment.

How do I need to prepare for the procedure?

• You should not eat for six hours before the procedure but you can drink clear fluids up until two hours before procedure. Clear fluids include water and diluted squash but not fruit juice, tea, coffee or milk.
• The exception to this information is if you have diabetes. If so, discuss with your doctor what you should do about your diabetes medication.
• Your treatment will be at Russells Hall Hospital or Corbett Outpatient Centre as an outpatient in the Day Surgery Unit (either a morning or an afternoon appointment). This will be confirmed at your clinic appointment.
• You will be at hospital for between two to four hours.
• You will need to arrange for someone to drive you home afterwards.
• Please arrange to have someone with you overnight.

• Please note that if you have sedation during the procedure:
  • You should not drive or operate machinery for 24 hours afterwards.
• You may not be able to co-operate during the procedure.
• You may not remember information given to you afterwards by your doctor. Your memory may be affected for up to 24 hours after the procedure.
  • The effect of the sedation may be prolonged by other drugs you are taking.

What do I do about medication?

• You should take all your regular medications except blood thinning medication such as clopidogrel, warfarin, dipyridamole, rivaroxaban. We will give you instructions about what to do about these drugs when you are given your appointment for the injection.
• Please bring a repeat prescription document with you if you are taking any regular medications.

What does the procedure involve?

Before the procedure

• A doctor will discuss the procedure with you and ask you to sign a consent form.

During the procedure (duration 30 to 60 minutes)

• This is carried out in theatre while you are awake.
• You may be offered sedation through an injection into the back of your hand to help you to relax.
• You will lie on your stomach with a pillow under your pelvis and your back or neck area will be cleaned with an antiseptic solution which may feel cold. Sterile sheets will then be placed around the area for injection. A local anaesthetic will be injected into your back or neck to numb the area.
• An X-ray will be used to ensure proper positioning of the radiofrequency needle and we may also use an ultrasound for guidance.
• Following positioning of the radiofrequency needle, we will use electrical stimulation to check that the position is correct – you may feel pressure, tingling or pulsing in area.
• After confirmation of the needle position, the RFA is carried out.
• The site will be injected with local anaesthetic and a steroid. You may feel some pressure and pushing whilst this procedure is being carried out but you should have no pain. If you do feel any discomfort, please tell a member of the theatre team.
• Once completed, a plaster will be placed over the injection site. You will then be taken to the recovery area.

After the procedure

• In the recovery area we will observe you for 30 minutes as you might feel a little drowsy and sleepy.
• You will also be offered light refreshments and after this you can go home.

What do I need to do when I go home?

When you get home, please continue to take any regular medication. It may be necessary for you to take painkillers for three to four days. You might need someone at home to help you but you do not have to stay in bed. The plaster can be removed the next day.

You should gradually increase your level of activity. However, do not take up new exercises until your muscles have had time to adapt. Build up your exercise levels by increasing your physical activity (e.g. walking, swimming, housework) gradually every few days. The eventual aim is to get back to a level of activity that is normal for you.

If you have any questions, or if there is anything you do not understand, please contact the Russells Hall Hospital switchboard number on 01384 456111 and ask for the relevant department who issued this leaflet.

If you have any feedback on this patient information leaflet please email dgft.patient.information@nhs.net

This leaflet can be made available in large print, audio version and in other languages, please call 0800 073 0510.

Originator:  Ruth Carter, Alifia Tameem. Date originated: July 2017. Date reviewed: January 2024. Next review date: October 2026. Version: 4. DGH ref: DGH/PIL/00971.