Percutaneous cryoanalgesia for pain palliation: Current status and future trends

Filippiadis, Dimitrios; Efthymiou, Evgenia; Tsochatzis, Athanasios; Kelekis, Alexis; Prologo, J. David

doi:10.1016/j.diii.2020.11.007

Cited by 25 publications

(14 citation statements)

References 59 publications

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“…For this reason, it has been used for a wide range of procedures, especially in adults, such as open thoracotomies, postherpetic neuralgia, postoperative inguinal herniorrhaphy, and joint pain. 8,11,[31][32][33][34][35][36] We have also found positive results in its application in the Ravitch technique for correction of PE and other thoracic deformities. 37,38 In its percutaneous modality, the most recent review reports three cases of mastectomy with very good results.…”

Section: Discussionmentioning

confidence: 94%

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

et al. 2021

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Introduction In recent years, pain protocols for pectus excavatum (PE) have incorporated cryoanalgesia through thoracoscopic approach. Since 2019, ultrasound-guided percutaneous cryoanalgesia (PCr) has been applied at our institution, either on the same day as the Nuss procedure or 48 hours before surgery. We carried out a preliminary retrospective review of patients with PE in whom PCr prior to surgery was performed at our institution between 2019 and 2021. Materials and Methods Two groups were evaluated: PCr on the same day (PCrSD) and PCr 48 hours before surgery (PCr48). Despite PCr, patients were treated with “patient-controlled analgesia” (PCA) with opioids for at least 24 hours, switching to conventional intravenous analgesia and oral analgesia in the following days. Demographic, clinical-radiological variables, PCA opioid use, pain grade according to the visual analog scale (VAS), and length of stay (LOS) were compared between the groups. A total of 20 patients were included (12 with PCrSD and 8 with PCr48), without significant differences in demographics or clinical-radiological variables. The overall median time of PCr was 65 minutes (55–127), with no differences between the groups. Results PCr48 group presented with significantly lower median number of hours of continuous PCA (24 vs. 32 hours; p = 0.031), lower median number of rescue boluses (11 vs. 18; p = 0.042), lower median VAS in the early postoperative hours (2 vs. 5.5; p = 0.043), and lower median LOS (3.5 vs. 5 days). Conclusion PCr performed 48 hours prior to surgery is more effective in terms of PCA requirements, VAS, and LOS when compared with cryoanalgesia on the same day.

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Section: Discussionmentioning

confidence: 94%

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

et al. 2021

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“…This idea is in line with the protocols established by Rettig et al or Di Fiore et al 30,31 Finally, percutaneous ultrasound-guided cryoanalgesia (PCr) contributes to the acquisition of skills for its potential use in other pediatric surgical interventions requiring short-and longterm pain control (painful burns of long evolution, rib fractures, palliative process, and lung transplantation...). 14,15,[32][33][34][35][36][37][38][39][40] The main limitation of our study was the small sample size, especially in the PCr24 group. On the other hand, we do not know the possible effects and complications that may appear in a longer follow-up.…”

Section: Discussionmentioning

confidence: 87%

“…It is a safe, reproducible technique with minimal risk of complications. 14,15 All this translates into numerous advantages over the thoracoscopic approach: it is more physiological for the patient, does not require selective intubation or onelung ventilation, avoids the need for bilateral thoracoscopy and additional incisions, and avoids potential thermal injuries due to contact with the cryoprobe. 16 On the other hand, anesthesiologists are familiar with ultrasound-guided percutaneous techniques for infiltration of local anesthetics, making it an attractive technique with a short learning curve and great collaboration between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

et al. 2022

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Introduction The addition of ultrasound-guided percutaneous cryoanalgesia (PCr) for pain management after pectus excavatum (PE) surgery offers a new and advantageous approach. Our aim is to describe our experience with PCr applied on the same day, 24 hours, and 48 hours prior to PE surgery. Material and Methods Prospective pilot study in patients undergoing ultrasound-guided PCr (2019–2022) was divided into three groups: PCr on the same day of surgery (PCrSD), PCr 24 hours before (PCr24), and PCr 48 hours before (PCr48). We describe the application of technique and data obtained by comparing the three groups. Results We present 42 patients (25 PCrSD, 11 PCr24, 6 PCr48). PCr24 had a shorter procedure duration than PCrSD (65.8 vs. 91.2 minute; p = 0.048). Related to analgesia, PCr24 and PCr48 showed lower opioid consumption than PCrSD in PCA volume (48.5 and 49.6 vs. 75.1 mL; p = 0.015) and PCA time (23.3 and 23.8 vs. 34.3 hours; p = 0.01). Degree of pain (VAS scale) on the day of surgery and on the second postoperative day was lower in PCr24 and PCr48 than in PCrSD (4 and 2 vs. 5; p = 0.012; 0 and 1 vs. 2; p = 0.01, respectively) as well as shorter hospital stay (3 and 3.5 vs. 5 days; p = 0.021). In addition, PCr24 showed lower opioid consumption and hospital stay than PCr48 (p > 0.05). The greatest savings in hospital costs were obtained in the PCr24 group. Conclusion PCr48 and PCr24 prior to PE surgery offers lower opioid consumption, less pain and shorter hospital stay than PCrSD. PCr24 is comparable to PCr48, but seems to show advantages and simpler logistics for the patient and the hospital.

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“…The fundamental goal when protecting a nerve from injury is to keep the juxtaneural temperature between 10 and 45 °C 1 2 3 4 5 6 7 8 9 10 11 as detailed in the thermoprotective temperatures given in Table 1 . The term “juxtaneural” is specified because the usual form of temperature confirmation is with a thermocouple placed adjacent to the nerve.…”

Section: Tablementioning

confidence: 99%

Thermal Protection Strategies and Neuromonitoring during Ablation

Sag

Husain

2022

Semin intervent Radiol

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Advanced interventional pain management approaches seek to lesion neural targets to achieve desirable analgesia; however, equally important is preservation of motor and sensory function for regional bystander nerves. The topic of neuroprotection is also relevant for thermal ablation of metastatic bone tumors in the vicinity of neural structures. This report aims to provide an IR-directed framework of thermoprotective techniques available during thermal ablation.

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Percutaneous cryoanalgesia for pain palliation: Current status and future trends

Cited by 25 publications

References 59 publications

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Percutaneous Cryoanalgesia: A New Strategy for Pain Management in Pectus Excavatum Surgery

Ultrasound-Guided Percutaneous Cryoanalgesia for Pectus Excavatum: When Should It be Applied?

Thermal Protection Strategies and Neuromonitoring during Ablation

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