Ultrasound-Guided Percutaneous Cryoneurolysis for Acute Pain Management

Abstract

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.

Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

“…An ultrasound-guided percutaneous technique has been recently described but is currently limited to short series of cases. 6,7 Preoperative ultrasound-guided percutaneous cryoanalgesia for use in treating acute postoperative pain in the orthopedic population has also been reported. 7 Like the previously described reports, the infrapatellar branch was targeted by preoperative cryoneurolysis in patients planned for TKA.…”

“…Percutaneous cryoneurolysis and peripheral nerve stimulation (PNS) are two modalities approved by the Food and Drug Administration (FDA) for use in treating acute pain; yet they have been nearly absent from the acute pain literature. [6][7][8] This article reviews these analgesic methods and their application to acute pain states, specifically for knee arthroplasty.…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25] More recently, cryoneurolysis was administered using a blind percutaneous approach using landmarks, 18 and subsequently using a percutaneous ultrasound-guided approach. 6,7 Most studies have involved application to sensoryonly nerves. Although mixed sensory-motor nerve treatment was reported without negative sequelae in preclinical 26,27 and clinical 28 settings, its safety and therapeutic profile have yet to be determined with adequately designed and powered trials.…”

Ultrasound-guided percutaneous cryoneurolysis for treatment of acute pain: could cryoanalgesia replace continuous peripheral nerve blocks?

“…Possible additional applications for treatment of acute pain extend beyond the operating room, and include rib fractures, painful burns with a long recovery period and palliative care. 13 The recently reported case in a patient with opioid-refractory pain caused by right foot burns demonstrates the utility of cryoneurolysis outside of the operating room. 13 While normally cryoneurolysis has been used to treat predominantly sensory-only nerves; 17 in this case, the most distal aspect of the posterior tibial nerve visualized by ultrasound was targeted as the majority of the pain was located in the plantar aspect of the toes and foot.…”

“…3 10 Relatedly, in the reported cases involving iliac crest bone harvesting, the superior cluneal nerves were targeted by applying superficial cryoneurolysis along the posterior aspect of the iliac crest. 13 Additionally, the superficial peroneal nerve was similarly treated in the patient with foot burns.…”