Intraoperative intercostal nerve cryoablation During the Nuss procedure reduces length of stay and opioid requirement: A randomized clinical trial

Graves, Claire E.; Moyer, Jarrett; Zobel, Michael J.; Mora, Roberto Bernabeu; Smith, Derek T.; O’Day, Maura; Padilla, Benjamin E.

doi:10.1016/j.jpedsurg.2019.02.057

Cited by 122 publications

(105 citation statements)

References 33 publications

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“…Cryoanalgesia creates wallerian degeneration without interrupting the myelin sheath and endoneurium, so we prefer the term of "cryoanalgesia" to the term "cryoablation" often reported in the literature and suggesting the (wrong) idea of removing something. Cryoanalgesia proved to be useful in terms of reduction of opioid consumption and hospital stay in previous experiences in North and South America [US (9)(10)(11)(12) and Argentina (13)]. Our experience is consistent with the other reported experiences, even if the protocols adopted and the cryogenic systems used are different from place to place.…”

Section: Discussionsupporting

confidence: 89%

“…In our experience, we did not find a 24 h (or more) delay of the peak cryoanalgesic effect, as reported by other Authors (18). Graves et al (11) described a gradual sensitivity recovery with a latero-medial progression, patients showed a total sensitivity recovery in 4 months. In our pilot study patients reported no more analgesia after 2 months.…”

Section: Discussionsupporting

confidence: 85%

“…According to the recent literature on cryoanalgesia in MIRPE, published from North and South America, cryoanalgesia has the potentiality to reduce analgesic consumption and length of hospitalization, but also to ameliorate persistent pain and facilitate return to normal activity (8)(9)(10)(11)(12)(13). However, the technique of cryoanalgesia was not homogeneous: in the reports available so far, different protocols, probes and different cryogenics systems were used, manufactured by US Companies (©AtriCure, Inc., Mason OH; Frigitronics R , Connecticut).…”

Section: Introductionmentioning

confidence: 99%

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A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

et al. 2021

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Introduction: Cryoanalgesia has been recently described as alternative technique for immediate and persistent pain treatment after pectus excavatum repair. Cryoanalgesia has the potentiality to reduce analgesic consumption and length of hospitalization. However, cryoanalgesia has not been standardized yet: the previous reports describe different techniques and systems and include only small series. In Europe, no reports on cryoanalgesia for pectus repair have been published so far.Materials and Methods: This is a prospective single center pilot study performed in adolescents undergoing minimally invasive pectus excavatum repair with a new cryoanalgesia system, using a probe designed specifically for thoracoscopy. This new double lumen probe has the theoretical advantage of freezing only in its tip, so reducing the risk of complications.Results: Seven patients undergoing pectus excavatum repair were treated with cryoanalgesia performed with the new probe. No complications of cryoanalgesia were reported. Total consumption of morphine during hospital stay was between 0.1 and 0.35 mg/kg, with no side effects reported. Mean time to discharge was 2.4 days. All patients reported a good pain control with a fair need of rescue medications for pain relief during the first week after discharge, and a very good pain control without need of rescue medications during following weeks.Conclusions: Our pilot study showed that the new cryoanalgesia device is efficacious in terms of pain control, hospital stay and resumption of post-operative activities. The cryoprobe designed allowed an easy and safe maneuver. A prospective trial is needed to better define the risks and benefits of this technique.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

et al. 2021

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“…In 2019, Graves et al 9 executed a randomized clinical trial of 20 patients undergoing the Nuss procedure who received either cryoneurolysis (n=10) or thoracic epidural (n=10). Patients receiving cryoneurolysis had decreased length of stay (3 vs. 5 days, p=0.0001) and fewer inpatient opioids (mean decrease of 416 mg oral morphine equivalent, p=0.0001).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Péter

Min

Patil

et al. 2021

Trauma Surg Acute Care Open

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BackgroundThere is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.MethodsA systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.ResultsTwenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.ConclusionsGiven the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.Level of evidenceLevel IV systematic reviews and meta-analyses.

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“…[5][6][7] For example, a recent randomized trial by Graves et al demonstrated that intercostal nerve cryoablation during surgical correction of pectus excavatum decreases length of hospital stay and opiate analgesic requirement compared with thoracic epidural analgesia, without complications. 8 The cryoablation group's median length-of-stay was decreased by 2 days and opioid analgesic requirements were reduced by 52 to 82% compared with the thoracic epidural treatment group. A similar retrospective study of 26 patients drew similar conclusions.…”

Section: Introductionmentioning

confidence: 89%

Interventional Cryoneurolysis: What Is the Same, What Is Different, What Is New?

Bittman

Behbahani

Gonzalez

et al. 2019

Semin intervent Radiol

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Cryoneurolysis is the deliberate application of cold temperatures to nerves for therapeutic purposes. The idea of treating pain with this technique is thousands of years old and has evolved over time through the application of surgical techniques, nerve stimulation and/or landmark guidance, and through device development. Recent integration of the interventional radiology skill set to this space has unlocked a myriad of opportunities—primarily through a unique ability to percutaneously access deep structures in the body with accuracy and precision, and the capacity to monitor ablation zones. Understanding of the specific neurohistological process that follows targeted cryoneurolysis leads to new options for treating patients in pain without drugs and opens doors for the potential modification of a wide array of disease states.

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Intraoperative intercostal nerve cryoablation During the Nuss procedure reduces length of stay and opioid requirement: A randomized clinical trial

Cited by 122 publications

References 33 publications

A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

A New Device for Thoracoscopic Cryoanalgesia in Pectus Excavatum Repair: Preliminary Single Center Experience

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Interventional Cryoneurolysis: What Is the Same, What Is Different, What Is New?

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