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Physiological and functional responses of water-cooled versus traditional radiofrequency ablation of peripheral nerves in rats
  1. Christa Zachariah1,
  2. Jacques Mayeux1,
  3. Guillermo Alas1,
  4. Sherry Adesina1,
  5. Olivia Christine Mistretta2,
  6. Patricia Jill Ward2,
  7. Antonia Chen3,
  8. Arthur William English2 and
  9. Alencia V Washington1
  1. 1Research and Development, Avanos Medical Inc, Alpharetta, Georgia, USA
  2. 2Department of Cell Biology, Emory University, Atlanta, Georgia, USA
  3. 3Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Christa Zachariah, Research and Development, Avanos Medical Inc, Alpharetta, GA 30004, USA; christacaesar{at}


Background and objectives Several clinical studies have focused on assessing the effectiveness of different radiofrequency ablation (RFA) modalities in pain management. While a direct head-to-head clinical study is needed, results from independent studies suggest that water-cooled RFA (CRFA) may result in longer lasting pain relief than traditional RFA (TRFA). The primary purpose of this study was, therefore, to investigate in a preclinical model, head-to-head differences between the two RFA technologies.

Methods RFA was performed in a rat sciatic nerve model (n=66) in two groups: (1) TRFA or (2) CRFA. The surgeon was not blinded to the treatment; however, all the physiological endpoints were assessed in a blinded fashion which include histological, MRI, and nerve function assessment via electromyography.

Results The energy delivered by the generator for CRFA was significantly higher compared with TRFA. Histological staining of nerves harvested immediately following CRFA exhibited extended length and multiple zones of thermal damage compared with TRFA-treated nerves. MRI scans across 4 weeks following treatment showed edematous/inflammatory zones present for longer times following CRFA. Finally, there was greater attenuation and prolonged loss of nerve function measured via electromyography in the CRFA group.

Conclusions This study shows that CRFA has greater energy output, as well as more pronounced structural and functional changes elicited on the peripheral nerves compared with TRFA. While these preclinical data will need to be confirmed with a large clinical randomized controlled trial, we are encouraged by the direction that they may have set for those trials.

  • radiofrequency ablation
  • interventional pain management
  • chronic pain
  • animal studies

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  • Contributors Each named author has substantially contributed to conducting the underlying research (planning, execution, data analysis and interpretation) and drafting of this manuscript.

  • Funding This study was funded by Avanos Medical Inc.

  • Competing interests CZ was employed by Avanos Medical as a Research Scientist. JM was employed by Avanos Medical as a Senior Research Scientist. GA is employed by Avanos Medical as a Research Scientist. SA was employed by Avanos Medical as a Research Scientist. AC reports personal fees from SLACK publishing, other from Joint Purification Systems, personal fees from Stryker, personal fees from bOne, other from Sonoran Biosciences, other from Graftworx, grants from OREF, personal fees from Pfizer, personal fees from Avanos, personal fees from Irrisept, personal fees from Convatec, personal fees from 3M, personal fees from Recro, personal fees from Heraeus, other from Hyalex, personal fees from DePuy, other from The Journal of Bone and Joint Surgery, personal fees from GLG, personal fees from UpToDate, outside the submitted work; and Editorial board: Journal of Arthroplasty; Annals of Joint; Bone and Joint 360 Journal; Clinical Orthopaedics and Related Research; Healthcare Transformation; Journal of Bone and Joint Infection; Knee Surgery, Sports Traumatology, Arthroscopy. Board / committee member: AAOS, AJRR, AAHKS, European Knee Association, International Congress for Joint Reconstruction, Musculoskeletal Infection Society. AWE reports personal fees from AVANOS Medical Science Advisory Board, outside the submitted work; AVW was employed by Avanos Medical as a Manager.

  • Patient consent for publication Not required.

  • Ethics approval All procedures were approved by 4P Labs or Emory University Institutional Animal Care and Use Committee (IACUC).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Any additional information desired may be requested from corresponding author.

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