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

Ilfeld, Brian M.; Gabriel, Rodney A.; Trescot, Andrea M.

doi:10.1093/bja/aex142

Cited by 42 publications

(50 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…16,[19][20][21] The consequence is that cryoneurolysis is optimally applied when prolonged analgesia is required; yet an extended and somewhat unpredictable duration of hypesthesia, muscle weakness (or paralysis), and possibly decreased proprioception are acceptable. 22 There are therefore limited applications involving acute pain (table 2); however, for circumstances in which these limitations are acceptable, a peripheral nerve block using cryoneurolysis appears to be a promising analgesic technique with a unique duration of action orders of magnitude beyond current local anesthetics. 22…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Ilfeld¹,

Finneran²

2020

Anesthesiology

View full text Add to dashboard Cite

Two regional analgesic modalities currently cleared by the U.S. Food and Drug Administration hold promise to provide postoperative analgesia free of many of the limitations of both opioids and local anesthetic-based techniques. Cryoneurolysis uses exceptionally low temperature to reversibly ablate a peripheral nerve, resulting in temporary analgesia. Where applicable, it offers a unique option given its extended duration of action measured in weeks to months after a single application. Percutaneous peripheral nerve stimulation involves inserting an insulated lead through a needle to lie adjacent to a peripheral nerve. Analgesia is produced by introducing electrical current with an external pulse generator. It is a unique regional analgesic in that it does not induce sensory, motor, or proprioception deficits and is cleared for up to 60 days of use. However, both modalities have limited validation when applied to acute pain, and randomized, controlled trials are required to define both benefits and risks.

show abstract

Section: Mechanism Of Actionmentioning

confidence: 99%

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Ilfeld¹,

Finneran²

2020

Anesthesiology

View full text Add to dashboard Cite

show abstract

“…In contrast to the mainly mechanical contusion impacts on the spinal cord used to simulate spinal cord injury, we modeled the glial scar using an original technique of local low-temperature spinal cord injury. The idea’s prototype was the experiment of using cryotechnologies for cryoanalgesia of peripheral nerves and cryodestruction of central nervous system tissue [5, 6, 7].…”

Section: Resultsmentioning

confidence: 99%

“…Our research team developed an approach to the modeling of SCI that uses an original cryoapplicator. The proposed innovative method for the modeling of a standard glial scar by means of cryoapplication is based on research by Vasiliev S.A. et al on the cryodestruction of the spinal cord [5, 6], as well as on methods of nerve cryoanalgesia [7].…”

Section: Introductionmentioning

confidence: 99%

Surgical Simulation of a Posttraumatic Spinal Cord Glial Scar in Rats

et al. 2019

View full text Add to dashboard Cite

We developed and verified an original, minimally invasive method for surgical simulation of a posttraumatic spinal cord glial scar in rats. The model is intended for use as a biological platform for testing the stimulation of regenerative processes in the central nervous system. Unification of the model enables one to achieve versatility both for implantation techniques and for the development of system-action approaches. Faced with a standard structural defect of the spinal cord, researchers will have the unique opportunity to test in vivo promising methods for spinal function recovery in the posttraumatic period. We developed anesthetic support, surgical tactics, and a set of rehabilitation measures for the chronic postoperative period. Experimental exposure effects were preliminarily assessed in vivo using a standard technique for recording the motor activity of rats in the postoperative period of spinal cord injury. Our final conclusions were drawn based on an analysis of histological sections of the rat spinal cord glial scar in three mutually perpendicular planes.

show abstract

“…Relative contraindications include Reynaud syndrome, cryoglobulinemia, and cold urticaria. 34 The associated prolonged total sensory, motor, and proprioception block combined with an unpredictable duration of action (weeks to months) is not appropriate in most clinical scenarios involving acute pain with the one potential exception being the treatment of the anterior femoral cutaneous and infrapatellar branch of the saphenous nerve for knee surgery, such as knee arthroplasty. 18,32 Similar to traditional needle-based percutaneous regional anesthesia techniques, potential complications of cryoneurolysis include bleeding, bruising, and infection.…”

Section: Potential Risksmentioning

confidence: 99%

Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

Gabriel

2018

Anesthesiology Clinics

View full text Add to dashboard Cite

Maximizing analgesia is critical following joint arthroplasty because postoperative pain is a major barrier to adequate physical therapy. Continuous peripheral nerve blocks have been the mainstay for acute pain management in this population; however, this and similar techniques are limited by their duration of action. Cryoneurolysis and peripheral nerve stimulation are two methodologies used for decades to treat chronic pain. With the advent of portable ultrasound devices and percutaneous administration equipment, both procedures may now be suitable for treatment of acute pain. This article reviews these two modalities and their application to joint arthroplasty.

show abstract

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

Cited by 42 publications

References 23 publications

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Cryoneurolysis and Percutaneous Peripheral Nerve Stimulation to Treat Acute Pain

Surgical Simulation of a Posttraumatic Spinal Cord Glial Scar in Rats

Novel Methodologies in Regional Anesthesia for Knee Arthroplasty

Contact Info

Product

Resources

About