Ultrasound-Guided Percutaneous Cryoneurolysis for Postoperative Analgesia After Limb Amputation: A Case Series

Gabriel, Rodney A.; Finneran, John J.; Trescot, Andrea M.; Ilfeld, Brian M.

doi:10.1213/xaa.0000000000000893

Cited by 22 publications

(15 citation statements)

References 29 publications

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“…Percutaneous ultrasound-guided cryoanalgesia has been previously described for a few acute pain indications, both perioperative and unrelated to surgery [2,[4][5][6]. However, its application to mastectomy appears to be particularly suitable due to various factors, including (1) the near-total coverage of the surgical site with the blocks; (2) the relative insignificance of cryo-induced sensory and motor block; and, (3) the similar durations of post-mastectomy pain and cryoneurolysis.…”

Section: Discussionmentioning

confidence: 99%

“…The result is a temporary sensory and motor nerve block with a duration measured in weeks and occasionally months without any delivery device to manage or infusion pump to remove [2]. While described extensively in the chronic pain literature [3], recently published case reports support the use of ultrasound-guided percutaneous cryoneurolysis for the treatment of acute postoperative pain [2,[4][5][6]. Given its analgesic duration roughly corresponds to that of post-mastectomy pain, cryoanalgesia is a possible analgesic option.…”

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confidence: 99%

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Ultrasound-guided percutaneous intercostal cryoanalgesia for multiple weeks of analgesia following mastectomy: a case series

Gabriel

Finneran

Swisher

et al. 2020

Korean J Anesthesiol

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Background: Acute post-mastectomy pain is frequently challenging to adequately treat with local anesthetic-based regional anesthesia techniques due to its relatively long duration measured in multiple weeks. Case: We report three cases in which preoperative ultrasound-guided percutaneous intercostal nerve cryoneurolysis was performed to treat pain following mastectomy. Across all postoperative days and all three patients, the mean pain score on the numeric rating scale was 0 for each day. Similarly, no patient required any supplemental opioid analgesics during the entire postoperative period; and, no patient reported insomnia or awakenings due to pain at any time point. This was a significant improvement over historic cohorts. Conclusions: Ultrasound-guided percutaneous cryoanalgesia is a potential novel analgesic modality for acute pain management which has a duration that better-matches mastectomy than other currently-described techniques. Appropriately powered randomized, controlled clinical trials are required to demonstrate and quantify both potential benefits and risks.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Ultrasound-guided percutaneous intercostal cryoanalgesia for multiple weeks of analgesia following mastectomy: a case series

Gabriel

Finneran

Swisher

et al. 2020

Korean J Anesthesiol

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“…Axons regenerate along the undisturbed epineurium, perineurium, and endoneurium from the site of ablation towards their distal targets at about 1–2 mm/day,3 resulting in a nerve block with a variable duration, but typically measured in multiple weeks 4. While cryoanalgesia has been used for decades to treat primarily chronic pain,4–8 the advent of percutaneous cannulas and ultrasound guidance dramatically increases the potential applications for its use in treating acute pain as well 9–11…”

Section: Introductionmentioning

confidence: 99%

Does cryoneurolysis result in persistent motor deficits? A controlled study using a rat peroneal nerve injury model

Shah

Bremner

Esparza

et al. 2020

Reg Anesth Pain Med

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BackgroundCryoneurolysis of peripheral nerves uses localised intense cold to induce a prolonged block over multiple weeks that has the promise of providing potent analgesia outlasting the duration of postoperative pain following surgery, as well as treat other acute and chronic pain states. However, it remains unclear whether persistent functional motor deficits remain following cryoneurolysis of mixed sensorimotor peripheral nerves, greatly limiting clinical application of this modality. To help inform future research, we used a rat peroneal nerve injury model to evaluate if cryoneurolysis results in persistent deficits in motor function.MethodsMale Lewis rats (n=30) had their common peroneal nerves exposed bilaterally at the proximal lateral margin of the knee and subsequently underwent cryoneurolysis on one limb and sham treatment on the contralateral limb. Outcomes were evaluated on days 3, 14, 30, 90 and 180. The primary end point was motor function, based on ankle dorsiflexion torque. In addition, sensory function was tested based on von Frey’s filament sensitivity to the peroneal sensory distribution. A subset of animals was sacrificed following functional testing at each time point, and general tissue morphology, connective tissue deposition, and axon counts were evaluated.ResultsMotor deficits in treated limbs were observed at 3 and 14 days but had resolved at time points beyond 1 month. Bilateral sensory deficits were also observed at 3 and 14 days, and also resolved within 1 month. Consistent with motor functional deficits, axon counts trended lower in treated nerves compared with contralateral controls at 3 days; however, axon counts were not significantly different at later time points.ConclusionsWhen applied to a mixed sensorimotor nerve, cryoneurolysis did not result in persistent motor deficits.

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“…This technique, which uses freezing temperatures (−70°C) to reversibly ablate nerves, has been used by anesthesiologists to successfully treat both acute and chronic pain. [4][5][6][7] Given the duration of the induced block, the analgesia provided may be better matched to the expected duration of pain associated with STSG and burn care.…”

mentioning

confidence: 99%

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Cryoneurolysis for Analgesia in Patients With Burns

Finneran

Swisher

Gabriel

et al. 2019

Journal of Burn Care &Amp; Research

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Autologous skin grafting from the thigh is frequently required for treatment of burns and is associated with intense pain at the donor site. Local anesthetic–based (LA) nerve blocks of the lateral femoral cutaneous nerve (LFCN) have been demonstrated to provide analgesia when the graft is taken from the lateral thigh. However, the duration of these single injection blocks has been reported to average only 9 hours, whereas the pain from the procedure lasts days or weeks. Continuous LA nerve blocks can also be used to provide analgesia during serial debridement of burns, although this requires placement of a perineural catheter which may increase infection risk in a population with an increased susceptibility to infection. Cryoneurolysis of the LFCN can potentially provide analgesia of the lateral thigh for skin graft harvesting or serial burn debridement that lasts far longer than conventional LA nerve blocks. Here, we present a series of three patients who received a combination of a LA nerve block and cryoneurolysis nerve block of the LFCN for analgesia of the lateral thigh. Two of these patients had the blocks placed before harvesting a split thickness skin graft. The third received the blocks for outpatient wound care of a burn to the lateral thigh. In all cases, the resulting analgesia lasted more than 1 week. A single cryoneurolysis block of the LFCN successfully provided extended duration analgesia of the lateral thigh for autologous skin graft donor site or wound care of a burn in three patients.

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Ultrasound-Guided Percutaneous Cryoneurolysis for Postoperative Analgesia After Limb Amputation: A Case Series

Cited by 22 publications

References 29 publications

Ultrasound-guided percutaneous intercostal cryoanalgesia for multiple weeks of analgesia following mastectomy: a case series

Ultrasound-guided percutaneous intercostal cryoanalgesia for multiple weeks of analgesia following mastectomy: a case series

Does cryoneurolysis result in persistent motor deficits? A controlled study using a rat peroneal nerve injury model

Ultrasound-Guided Lateral Femoral Cutaneous Nerve Cryoneurolysis for Analgesia in Patients With Burns

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