Cryoanalgesia for relief of pain after thoracotomy.

Maiwand, Omar; Makey, A. R.

doi:10.1136/bmj.282.6278.1749

Cited by 66 publications

(16 citation statements)

References 6 publications

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“…Role of cryoanalgesia in the control ofpost thoracotomy pain the initial postoperative period,3 and in some cases this has been combined with a subjective assessment of pain by the patient. 4 The technique of applying the cryoprobe was similar to that used in most of the trials claiming this technique to be beneficial, although one trial used a two minute freeze3 and in another a 30 second freezethaw cycle was repeated. 4 The temperature to which the intercostal nerve is frozen and the duration of cryoprobe application have been matters for discussion.…”

Section: Discussionmentioning

confidence: 99%

“…4 The technique of applying the cryoprobe was similar to that used in most of the trials claiming this technique to be beneficial, although one trial used a two minute freeze3 and in another a 30 second freezethaw cycle was repeated. 4 The temperature to which the intercostal nerve is frozen and the duration of cryoprobe application have been matters for discussion. There is general agreement that interruption of conduction becomes prolonged at a temperature between -5°and -20'C.…”

Section: Discussionmentioning

confidence: 99%

“…Role of cryoanalgesia in the control ofpost thoracotomy pain the initial postoperative period,3 and in some cases this has been combined with a subjective assessment of pain by the patient. 4 The fact that both epidural and systemic narcotics were given on a dose-weight basis enabled the postoperative analgesia to be numerically ranked, thus enabling objective analysis of drug requirement throughout the whole postoperative period. This arbitary ranking is open to criticism, but both graphs show similar changes with time and this lends credence to the technique.…”

Section: Discussionmentioning

confidence: 99%

“…4 The temperature to which the intercostal nerve is frozen and the duration of cryoprobe application have been matters for discussion. There is general agreement that interruption of conduction becomes prolonged at a temperature between -5°and -20'C.…”

Section: Discussionmentioning

confidence: 99%

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Role of cryoanalgesia in the control of pain after thoracotomy.

Roxburgh¹,

Markland²,

Ross³

et al. 1987

Thorax

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Thoracotomy causes severe postoperative pain, which is difficult to manage since the use of systemic analgesics often causes respiratory depression. Cryoanalgesia of the intercostal nerves has been advocated as an effective means of local analgesia without serious side effects. A prospective randomised blind trial to investigate the efficacy of the technique was carried out. A total of 53 patients undergoing thoracotomy were allocated to either the trial or a control group. At thoracotomy the surgeon was informed of the patient's trial allocation. The trial group received one minute of direct cryotherapy to at least five intercostal nerves related to the incision. All patients received methadone via the lumbar epidural route in a dose calculated according to their weight. A linear analogue assessment of postoperative pain was made by the patients as soon as they were sufficiently awake. An independent record of all postoperative analgesia was kept. After discharge from hospital further assessments were made at least six weeks after operation. Statistical analysis of the scores of postoperative pain and analgesic consumption showed that there was no significant difference between the trial and the control group. There was, however, a suggestion of an increase in the long term morbidity, although these figures were not amenable to statistical analysis. Thus it has not been possible to demonstrate a role for cryoanalgesia in the control of post thoracotomy pain.The control of postoperative pain is particularly important in thoracic surgery. Adequate postoperative analgesia must be provided without impairing the remaining respiratory function. There has therefore been some recent interest in local methods of pain relief. It has been shown by this unit that the use of epidural methadone is an effective and safe way of providing analgesia during the early postoperative phase.' It cannot, however, be used for a prolonged period and therefore interest has been focused on cryoanalgesia, which has been said to provide pain relief for up to 26 days.2 Although there are favourable reports of its efficacy,34 the impression in this unit was that there was no subjective benefit. A prospective randomised trial was therefore devised to investigate the effect of adding cryoanalgesia to a standard postoperative analgesic regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Role of cryoanalgesia in the control ofpost thoracotomy pain the initial postoperative period,3 and in some cases this has been combined with a subjective assessment of pain by the patient. 4 The fact that both epidural and systemic narcotics were given on a dose-weight basis enabled the postoperative analgesia to be numerically ranked, thus enabling objective analysis of drug requirement throughout the whole postoperative period. This arbitary ranking is open to criticism, but both graphs show similar changes with time and this lends credence to the technique.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Role of cryoanalgesia in the control of pain after thoracotomy.

Roxburgh¹,

Markland²,

Ross³

et al. 1987

Thorax

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“…Fifty-two obtained relief of pain for a median duration of 11 days and with a range of up to 224 days. Cryoanalgesia is also being used in the treatment, or prevention, of post-thoracotomy pain by freezing the relevant intercostal nerves (Glynn, Lloyd and Barnard, 1980;Katz et al, 1980;Maiwand and Makey, 1981).…”

mentioning

confidence: 99%

Cryogenic Damage to Peripheral Nerves and Blood Vessels in the Rat

Marsland¹,

Ramamurthy²,

Barnes³

1983

British Journal of Anaesthesia

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The effects of cryogenic injury on femoral blood vessels and nerves were studied in 28 rats. The femoral neurovascular bundles were dissected out bilaterally and the vessels and nerves subjected to cryogenic injury. The rats were sacrificed at intervals of up to 2 weeks. Damage to the nerves and to a number of femoral vessels was severe and included necrosis and thrombus formation. The results indicate that significant vascular damage can occur during cryotherapy, and the possible complications of this should be considered.

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Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics

Sabanathan

Mearns

Smith

et al. 1990

Journal of British Surgery

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To assess the efficacy of continuous extrapleural intercostal nerve block on postoperative pain and pulmonary function, a prospective, randomized, double-blind, placebo-controlled trial was conducted on 56 patients undergoing elective thoracotomy. Infusion was started before closing the chest and was continued for 5 days. Subjective pain relief was assessed on a linear visual analogue scale. Pulmonary function was measured on the day before operation and daily for 5 days. There were 29 patients in a group which received bupivacaine and 27 in a control group which received saline. The bupivacaine group had lower pain scores (P less than 0.01) and required less papaveretum (P less than 0.01) than the control group. Forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate were maximally reduced at 24 h to median values of 56, 60 and 57 per cent, respectively, of preoperative control values in the bupivacaine group, and to 25, 30 and 32 per cent in the control group. These differences are highly significant (P less than 0.01). Restoration of pulmonary function was superior in the bupivacaine group (P less than 0.01). There were no infusion-related complications. After thoracotomy, continuous intercostal blockade with bupivacaine is a safe and effective method of pain relief which reduces the early loss of postoperative pulmonary function significantly and more rapidly restores respiratory mechanics.

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Cryoanalgesia for relief of pain after thoracotomy.

Cited by 66 publications

References 6 publications

Role of cryoanalgesia in the control of pain after thoracotomy.

Role of cryoanalgesia in the control of pain after thoracotomy.

Cryogenic Damage to Peripheral Nerves and Blood Vessels in the Rat

Efficacy of continuous extrapleural intercostal nerve block on post-thoracotomy pain and pulmonary mechanics

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