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Cryoanalgesia
Published in Harald Breivik, William I Campbell, Michael K Nicholas, Clinical Pain Management, 2008
Gunnvald Kvarstein, Henrik Högström
Applying cold to tissues to relieve pain has been recognized for thousands of years. In 1917, Trendelenberg1 demonstrated that freezing a nerve leads to reversible nerve injury without neuroma formation. In 1967, Amoils and coworkers2 introduced a hand-held device to freeze tissue, using carbon dioxide or nitrous oxide. Ten years later, Lloyd et al.3 brought the cryoprobe into pain therapy. Cryoanalgesia, in the sense of cryoneurolysis or cryoablation of nervous tissue is an interventional technique with the ability of providing long-lasting pain relief. This chapter aims to cover the basic principles of this method, and some of its most common clinical applications.
Nerve blocks: chemical and physical neurolytic agents
Published in Nigel Sykes, Michael I Bennett, Chun-Su Yuan, Clinical Pain Management, 2008
Cryoneurolysis of the intercostal nerves during surgery is the best-known application of cryotherapy for the treatment of acute post-thoracotomy pain.31 A number of reports have described effective pain management in this situation, especially when combined with other analgesic treatments.32, 33 However, the occurrence of chronic dysesthetic pain has led a number of surgeons to abandon its routine use.
The expanding role of chronic pain interventions in multimodal perioperative pain management: a narrative review
Published in Postgraduate Medicine, 2022
Ying Ye, Rodney A. Gabriel, Edward R. Mariano
Cryoneurolysis, or cryoanalgesia, in which targeted nerves are temporarily ablated using low temperatures, is an established chronic pain procedure that has shown recent potential as an acute pain management modality in the perioperative setting. Using agents such as carbon dioxide or nitrous oxide, cryoneurolysis causes second-degree injury to the peripheral nerve and temporarily blocks nerve conduction with resulting analgesia. The nerves undergo reversible Wallerian degeneration followed by slow regeneration of the nerve[21]. Recent developments in percutaneous cryoneurolysis devices have allowed the application of this technique beyond chronic pain treatment[22]. In one case study, patients undergoing mastectomy procedures received ultrasound-guided percutaneous cryoneurolysis to the intercostal nerves; all three patients reported no pain or opioid use during the postoperative period[23]. Preoperative cryoneurolysis has also been effective in controlling postoperative pain in patients undergoing rotator cuff repair[24], TKA[24], and limb amputation[25]. Case reports also describe effective use of cryoneurolysis in the postoperative setting for refractory surgical pain [26] and phantom limb pain[25]. Experiences from these case reports suggest an increasing role of cryoneurolysis in acute pain management.
Percutaneous cryoneurolysis for acute pain management: current status and future prospects
Published in Expert Review of Medical Devices, 2021
John J. Finneran IV, Brian M. Ilfeld
The duration of action of cryoneurolysis – dependent on the 1–2 mm per day regeneration rate of the treated axons – while greatly appealing from a pain control perspective, is simultaneously a limiting factor in its application. Weeks or months of muscle weakness is often unacceptable due to both negatively affecting participation in in physical rehabilitation and interference with activities of daily living. Indeed, it is the goal of utilizing regional anesthetics to improve participation in physical rehabilitation and hasten return to activities of daily living. Therefore, large nerves commonly blocked by regional anesthesiologists (e.g. femoral, sciatic, brachial plexus) are usually poor candidates for cryoneurolysis. Cryoneurolysis is optimally applied to nerves that have little or no motor function, or in situations where the innervated muscle is no longer functional or present (e.g. amputation). Nevertheless, for the limited applications that will be described, cryoneurolysis has the potential to provide pain relief that far surpasses the duration of other available regional anesthetics [4,5].