Evaluation of Intercostal Cryoanalgesia versus Conventional Analgesia in Postthoracotomy Pain

Abstract

The objective of the study was to evaluate the effects of cryoanalgesia in patients undergoing posterolateral thoracotomy. A double-blind randomized and prospective study was performed in 100 patients undergoing thoracotomy. They were randomized into two groups: Group A, 55 patients, who had undergone an intercostal cryoanalgesia and group B, control, 45 patients treated only with pharmacological analgesia ad libitum. In both groups we assessed pain in the first 7 postsurgical days, the amount of analgesia required, electromyography of the intercostal muscles involved and recording of maximal static respiratory pressures. Postsurgical pain was significantly lower (p < 0.001) in group A. No patient in group A needed major analgesia and the amount of aminopyrines required was significantly lower (p < 0.001) than those used in group B. Maximal static inspiratory pressure (P_Imax) showed no significant changes and no significant differences were found between the two groups. Maximal static expiratory pressure (P_Emax) significantly decreased (p < 0.001) in the 1st and 2nd week and it was not related to the type of analgesia used. We advocate the use of cryoanalgesia since it significantly reduces pain as well as the doses of analgesia.

Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway

“…Other approaches aim at a cryoanalgesia [20] and muscle sparing mini thoracotomy [11]. In the treatment of post-thoracotomy pain thoracic epidural anesthesia appears to be superior to patient controlled intravenous opioid-based analgesia [21].…”

Painful Neuromas

“…The first use of cryoanalgesia for intractable pain was described by Lloyd et al 83 Cryotherapy has been used to treat chronic neuropathic pain conditions including trigeminal neuralgia, neuropathic groin pain, and postthoracotomy pain. [84][85][86][87][88][89][90][91][92] The technique involves using repeated, short, freeze-thaw cycles to cause axonal degeneration, yet preserving the epineurium and perineurium, allowing for axonal regeneration subsequently. 93 More recently, ultrasound-guided cryotherapy has been shown to be efficacious in the treatment of residual limb neuromas.…”

Randomized comparative clinical study of cryoanalgesia versus topical anesthesia in clear corneal phacoemulsification

“…Cryoanalgesia has been successfully used in thoracic surgery for lung lobectomy through a minithoracotomy 6,7 and in the treatment of postoperative pain following thoracotomy, 8 hip adductor spasticity, and obturator neuralgia. 9 About 30 years ago, Krwawicz 10 performed the first cataract operation involving cryoextraction of the lens.…”