Clinical Research Directory

· Super-voltage pulsed radiofrequency (PRF) of the stellate ganglion was performed under strict aseptic precautions with standard monitoring. Patients were positioned supine with a slight extension of the neck and head turned contralaterally. Ultrasound guidance using a high-frequency linear transducer was employed to identify the stellate ganglion region at the level of the C6 transverse process, anterior to the longus colli muscle and medial to the carotid sheath. A 22-gauge radiofrequency cannula (5-10 cm length, 5-mm active tip) was advanced using an in-plane technique until the needle tip was positioned adjacent to the sympathetic chain on the surface of the longus colli muscle. After negative aspiration, sensory (50 Hz) and motor (2 Hz) stimulation were performed to confirm appropriate needle placement and exclude somatic nerve involvement. Pulsed radiofrequency was then delivered using a supervoltage protocol with a pulse width of 20 ms at a frequency of 2 Hz, applied

Position the patient prone with bolsters to minimize lordosis and allow C- arm AP and oblique imaging. Under sterile conditions use fluoroscopy to identify T2 and T3 pedicles, ribs and transverse processes. A posterior paravertebral (transforaminal-style) approach is commonly used: advance a curved RFA cannula (20-22G, 10-15 cm with 5-10 mm active tip) under fluoroscopic AP and lateral guidance to the anterolateral aspect of the vertebral body or just anterior to the costotransverse junction at the T2 and T3 levels, the expected location of the thoracic sympathetic chain. Confirm needle position with small (0.5-1 mL) contrast injection to exclude intravascular or pleural spread. Perform sensory (50 Hz) and, if applicable, motor (2 Hz) stimulation to exclude intercostal motor/pleural/nerve root proximity. For supervoltage PRF, deliver radiofrequency with pulse width 20ms at 2 Hz while maintain the electrode tip temperatue less than 42°C for 120-240 seconds at each level