#coolief #### Results - 86% saw at least 50% relief of pain relief for up to 11 months #### Diagnosis - Chronic pain non-responsive to conservative therapy - Block of **obturator** and **femoral accessory** nerves - Greater than 80% pain relief #### Precautions - Nerve, artery and vein - Identify femoral pulse - needle entry to be made 2 cm or greater lateral to palpable femoral pulse - Can use ultrasound if desired #### Prognostic Block - AP fluoroscopy, 12 o'clock position on superior acetabulum - Use 25 gauge 3.5 in needle (Quinckie) - Inject 0.5-1ml volume of high potency local anesthetic (4% lidocaine or 0.75% bupivicaine) #### RF Technique of Femoral Articular Branch - Identify target site on AP fluoroscopy - Palpate femoral arterial pulse and mark skin - At least 2 cm lateral to the femoral arterial pulse, use skin wheal of local anesthetic prior to insertion of COOLIEF* Cooled RF introducer - Advance COOLIEF* Cooled RF introducer under fluoroscopy to the 12 o'clock superior acetabular target site where osseous acetabulum is contacted - Initiate 2 Hz motor stimulation up to 1-2V affirming lack of muscle contractions to avoid lesioning motor branches near the RF probe tip - Inject 1-2 ml of local anesthetic through the COOLIEF* Cooled RF introducer prior to lesioning #### RF Technique of Obturator Articular Branch - Step #1 - Mark the Inguinal ligament, femoral crease, and femoral artery - Step #2 - Correct Fluoroscopy Technique - Ensure symmetry of obturator foramen THEN center femoral head on screen - Step #3 - Identify Incisura Target and Go! - Identify incisura target as teardrop shape at the junction of the inferolateral pubic ramus and the ischium - Use 25-27 gauge 3.5 inch needle with a small distal bend, inserted just medial to the medial aspect of the femoral arterial pulse - Avoid the femoral nerve, artery and where possible, the femoral vein. Advance needle in a sagittal plane under fluoroscopy until needle tip is deep to the femoral neurovascular sheath, then direct needle as required to contact the bony ischia adjacent to the teardrop - Aspirate to ensure no blood return - Use 0.5-1 ml volume of contrast to verify non-vascular spread & appropriate anatomical coverage - Inject 0.5-1 ml volume of local anesthetic for the block (0.9cc = 12mm COOLIEF* Cooled RF lesion) - Step #4 - Visualize incisura and ischial tuberosity of fluoroscopy - Step #5 - Anesthetize from the Skin Entry site to the Anterior Ischium - Step #6 - Advance COOLIEF* Introducer towards lesion site along ramus - Step #7 - Final lesion position (2 lesions, one above the horizontal line and one below) - Motor testing Step #1 ![[Pasted image 20230219203531.png]] Step #2 ![[Pasted image 20230219204415.png]] Step #3 ![[Pasted image 20230219204432.png]] Step #4 ![[Pasted image 20230219213854.png]] Step #5 ![[Pasted image 20230219213923.png]] Step #6 ![[Pasted image 20230219213734.png]] Step #7 ![[Pasted image 20230219214014.png]]