Is a hypertonic solution useful in increasing the size of a burn field?

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Would a pre injection of a hypertonic solution such as hypertonic saline increase the size of the burn field for radio frequency ablation of targeted nerves?

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Interesting question. I haven't come across this in my own practice. It does seem to be effective at increasing the size when measured by imaging (https://pubmed.ncbi.nlm.nih.gov/29923949/).

Also, it seems to be particularly relevant for cancer treatment (or may other interventional radiology treatments), where larger sizes and complete coverage is extremely important. Also seems that when working near vascular structures the heat dissipation may have a negative impact on the ablation efficacy (https://pubmed.ncbi.nlm.nih.gov/29391896/).

However, I'll assume you're trying to treat medial branch nerves or something similar in an outpatient setting. I didn't see good evidence about this particular use on quick review. Given that, it doesn't seem worth it to me: the treatment area usually isn't very big, the solution will take extra effort, cost more, and isn't usually near a vascular structure.

Also, I think good needle placement is probably more useful in ensuring good coverage. We've always used a technique to "lay the needle flat" over the area. Some example images are here: https://theprocedureguide.com/fluoroscopic-guided-thoracic-lumbar-medial-branch-radiofrequency-ablation-technique-and-overview/

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