Cryoablation of Intercostal Nerves Decreased Narcotic Usage After Thoracic or Thoracoabdominal Aortic Aneurysm Repair

Clemence, Jeffrey; Malik, Aroosa; Farhat, Linda; Wu, Xiaoting; Kim, Karen M.; Patel, Himanshu J.; Yang, Bo

doi:10.1053/j.semtcvs.2020.01.008

Cited by 31 publications

(34 citation statements)

References 11 publications

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“…Starting 2012, Clemence et al 21 performed a retrospective cohort study on 117 patients undergoing open thoracic or thoracoabdominal aortic aneurysm repair. Twenty-five patients received cryoneurolysis.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Péter

Min

Patil

et al. 2021

Trauma Surg Acute Care Open

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BackgroundThere is a critical need for non-narcotic analgesic adjuncts in the treatment of thoracic pain. We evaluated the efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain, specifically addressing the applicability of intercostal cryoneurolysis for pain control after chest wall trauma.MethodsA systematic review was performed through searches of PubMed, EMBASE, and the Cochrane Library. We included studies involving patients of all ages that evaluated the efficacy of intercostal cryoneurolysis as a pain adjunct for chest wall pathology. Quantitative and qualitative synthesis was performed.ResultsTwenty-three studies including 570 patients undergoing cryoneurolysis met eligibility criteria for quantitative analysis. Five subgroups of patients treated with intercostal cryoneurolysis were identified: pectus excavatum (nine studies); thoracotomy (eight studies); post-thoracotomy pain syndrome (three studies); malignant chest wall pain (two studies); and traumatic rib fractures (one study). There is overall low-quality evidence supporting intercostal cryoneurolysis as an analgesic adjunct for chest wall pain. A majority of studies demonstrated decreased inpatient narcotic use with intercostal cryoneurolysis compared with conventional pain modalities. Intercostal cryoneurolysis may also lead to decreased hospital length of stay. The procedure did not definitively increase operative time, and risk of complications was low.ConclusionsGiven the favorable risk-to-benefit profile, both percutaneous and thoracoscopic intercostal cryoneurolysis may serve as a worthwhile analgesic adjunct in trauma patients with rib fractures who have failed conventional medical management. However, further prospective studies are needed to improve quality of evidence.Level of evidenceLevel IV systematic reviews and meta-analyses.

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Section: Resultsmentioning

confidence: 99%

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Péter

Min

Patil

et al. 2021

Trauma Surg Acute Care Open

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“…Indications and operative techniques for HCA has been extensively discussed in our previous paper. 8,9 HCA was the preferred technique compared to AC in patients with arch aneurysm (>4 cm) that require arch replacement with HCA, TAA/TAAA from chronic aortic dissection, inability to clamp the aorta for proximal anastomosis, and patients with connective tissue disease. AC was used in patients who had no arch or proximal descending thoracic aneurysm, a classic or frozen elephant trunk which did not have endoleak and require a replacement.…”

Section: Methodsmentioning

confidence: 99%

“…As discussed in our previous paper, a left posterior lateral incision was made during TAA repair and extended to the abdomen as a paramedian incision for TAAA repair. 9 In most TAAs, to repair the distal aortic arch or descending thoracic aorta, one skin incision was used with two separate thoracotomies either in the 4th and 7th intercostal space or 8th intercostal. A right thoracotomy was performed for descending thoracic aortic aneurysm.…”

Section: Operative Tehchniquementioning

confidence: 99%

Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair

Norton

Orelaru

Ahmad

et al. 2022

Journal of Cardiac Surgery

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Background To compare perioperative and midterm outcomes in thoracic and thoraco‐abdominal aortic aneurysm (TAA and TAAA) repair using hypothermic circulatory arrest (HCA) or aortic clamping (AC) with mild hypothermia. Methods From 2012 to 2021 there were 180 open repairs of a TAA or TAAA, of which 90 (50%) were done with HCA and 90 (50%) with aortic clamping with mild hypothermia. The indications for HCA were arch aneurysm, TAA from chronic aortic dissection, and inability to clamp the aorta for proximal anastomosis. Results Compared to AC, the HCA group had less prior descending aorta replacement/repair (9.1% vs. 32%, p = 0.0001). Intraoperatively, the HCA group had more TAAs (70% vs. 20%, p < 0.0001) while the AC group had more TAAAs (80% vs. 30%, p < 0.0001). HCA group had longer cardiopulmonary bypass times (242 vs. 181 min, p < 0.0001) but shorter cross‐clamp time (39 vs. 120 min, p < 0.0001) and lower temperatures (18°C vs. 34°C, p < 0.0001). Postoperatively, the HCA group had longer intubation times (31 vs. 26 h, p = 0.002), but all other postoperative outcomes including paralysis (2.2% vs. 8.9%, p = 0.08), and operative mortality (4.4% vs. 2.2%, p = 0.68) were similar between HCA and AC groups. Patient age was an independent risk factor for postoperative paralysis (OR 1.07, p = 0.03) while HCA was not significant (OR 0.37, p = 0.21). Five‐year survival was similar between HCA and AC groups (85% vs. 80%, p = 0.36). Conclusions Postoperative outcomes and midterm survival were acceptable in thoracic and thoracoabdominal aneurysm patients after HCA or AC. Both HCA and AC with mild hypothermia were valid approaches in TAA/A repair.

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“…Postoperatively, both patients recovered well with no complications and minimal pain due to intercostal nerve ablation. 2 Informed consent for patients included in this study has been waived by the University of Michigan Medical School institutional review board.…”

Section: Case Summariesmentioning

confidence: 99%

The challenges of novel interventions in complex aortic disease

2020

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Cryoablation of Intercostal Nerves Decreased Narcotic Usage After Thoracic or Thoracoabdominal Aortic Aneurysm Repair

Cited by 31 publications

References 11 publications

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review

Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair

The challenges of novel interventions in complex aortic disease

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