Cryoanalgesia

Ps, Kim; Fm, Ferrante

doi:10.1097/00000542-199808000-00036

Cited by 41 publications

(6 citation statements)

References 6 publications

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“…354 The largest limiting factors when applying this technique to acute pain states are (1) the inhibition of efferent signals effectively paralyzing innervated muscles; and (2) the relatively unpredictable duration of action measured in multiple weeks and often months. Therefore, the modality has historically been used to target sensory-only nerves, 388 although mixed motor-sensory nerves have been cryoablated to treat spasticity, 389 and preclinical studies found no lasting changes to the structure or function of motor nerves after remyelination. 386,387 Surgical procedures possibly amenable to cryoneurolysis include iliac crest bone harvesting (superficial superior cluneal nerves), total knee arthroplasty (anterior femoral cutaneous and infrapatellar saphenous nerves), various thumb surgeries (superficial branch of the radial nerve), rotator cuff repair (suprascapular nerve), and digit/limb amputations, among others.…”

Section: Cryoanalgesiamentioning

confidence: 99%

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

283

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A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim. Novel insertion sites include the adductor canal, interpectoral, quadratus lumborum, lesser palatine, ulnar, superficial, and deep peroneal nerves. Noteworthy new indications include providing analgesia after traumatic rib/femur fracture, manipulation for adhesive capsulitis, and treating abdominal wall pain during pregnancy. The preponderance of recently published evidence suggests benefits nearly exclusively in favor of catheter insertion using ultrasound guidance compared with electrical stimulation, although little new data are available to help guide practitioners regarding the specifics of ultrasound-guided catheter insertion (eg, optimal needle-nerve orientation). After some previous suggestions that automated, repeated bolus doses could provide benefits over a basal infusion, there is a dearth of supporting data published in the past few years. An increasing number of disposable infusion pumps does now allow a similar ability to adjust basal rates, bolus volume, and lockout times compared with their electronic, programmable counterparts, and a promising area of research is communicating with and controlling pumps remotely via the Internet. Large, prospective studies now document the relatively few major complications during ambulatory CPNB, although randomized, controlled studies demonstrating an actual shortening of hospitalization duration are few. Recent evidence suggests that, compared with femoral infusion, adductor canal catheters both induce less quadriceps femoris weakness and improve mobilization/ambulation, although the relative analgesia afforded by each remains in dispute. Newly published data demonstrate that the incidence and/or severity of chronic, persistent postsurgical pain may, at times, be decreased with a short-term postoperative CPNB. Few new CPNB-related complications have been identified, although large, prospective trials provide additional data regarding the incidence of adverse events. Lastly, a number of novel, alternative analgesic modalities are under development/investigation. Four such techniques are described and contrasted with CPNB, including single-injection peripheral nerve blocks with newer adjuvants, liposome bupivacaine used in wound infiltration and peripheral nerve blocks, cryoanalgesia with cryoneurolysis, and percutaneous peripheral nerve stimulation.

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Section: Cryoanalgesiamentioning

confidence: 99%

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ilfeld

2017

Anesthesia &Amp; Analgesia

283

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“…Cryoneurolysis has been in clinical use for more than 5 decades with no published cases of permanent nerve injury or neuroma 8 and no evidence of permanent or long-term changes to nerve function following repeated treatments after full axon regeneration. 9,10 Although 2 investigations demonstrated a statistically significant increase in neuropathic pain in patients who received cryoneurolysis administered via the surgical incision, 11,12 the majority of trials reported no increased risk of persistent postoperative pain. [13][14][15][16][17][18][19][20][21] Given the aforementioned studies, we felt the risk of long-term sequelae of cryoanalgesia was low, and the benefit of longterm control of acute pain was high in our 3 patients.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Cryoneurolysis for Acute Pain Management

et al. 2017

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We report 3 different cases in which ultrasound-guided percutaneous cryoneurolysis was performed to treat acute pain: 1 patient with refractory incisional pain after percutaneous nephrolithotomy; 1 patient with burns to the foot; and 1 patient with pain from iliac crest grafting. Acute pain associated with surgery or injury is a challenge to treat with local anesthetic-based regional anesthesia techniques when the anticipated pain duration exceeds a few days. Cryoneurolysis is an alternative analgesic method that utilizes extremely cold temperatures to reversibly ablate peripheral nerves and is potentially a novel method for acute pain management.

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“…There is increasing interest in further exploration of this technique which may have less risk of adverse effect as compared with chemoneurolysis. 89…”

Section: Neurolysismentioning

confidence: 99%

“…This approach has been described for use in obturator neurolysis for hip adductor spasticity. There is increasing interest in further exploration of this technique which may have less risk of adverse effect as compared with chemoneurolysis 89 …”

Section: Injectionsmentioning

confidence: 99%

Spasticity evaluation and management tools

Howard

Patel

2023

Muscle and Nerve

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Spasticity is a complex and often disabling symptom for patients with upper motor neuron syndromes. Although spasticity arises from neurological disease, it often cascades into muscle and soft tissue changes, which may exacerbate symptoms and further hamper function. Effective management therefore hinges on early recognition and treatment.To this end, the definition of spasticity has expanded over time to more accurately

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Cryoanalgesia

Cited by 41 publications

References 6 publications

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Continuous Peripheral Nerve Blocks: An Update of the Published Evidence and Comparison With Novel, Alternative Analgesic Modalities

Ultrasound-Guided Percutaneous Cryoneurolysis for Acute Pain Management

Spasticity evaluation and management tools

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