Percutaneous cryotherapy for post-thoracotomy neuralgia

Id, Conacher

doi:10.1016/0304-3959(86)90097-7

Cited by 25 publications

(6 citation statements)

References 2 publications

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“…In 1986, Conacher 22 performed a descriptive study on 14 patients undergoing US-guided percutaneous cryotherapy for persistent post-thoracotomy neuralgia. Four consecutive intercostal nerve levels encompassing the area of discomfort were ablated.…”

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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“…Direct vision intercostal cryoanalgesia performed peroperatively produces significant analgesia with fewer respiratory complications [8]. Percutaneous intercostal cryoanalgesia performed using conventional techniques resulted in significant failure rate [2]. The present study showed that the intercostal nerve does not commonly lie in the subcostal groove-and in fact did so in only 16 % of cadavers.…”

Section: Commentmentioning

confidence: 51%

“…The method of nerve block depends on walking a needle off the lower border of the rib to enter the subcostal groove. Using this technique with percutaneous cryoanalgesia Conacher [2] obtained poor results and suggested that this may have resulted from incomplete contact between the tip of the probe and the nerve.…”

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confidence: 99%

Anatomical Variation in the Position of the Proximal Intercostal Nerve

Hardy

1988

British Journal of Anaesthesia

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“…3 Clinical symptoms of chronic postthoracotomy pain include allodynia, hyperalgesia, hypoesthesia (numbness at the injured site), and unprovoked burning pain. 4,5 These characteristics are similar to those of neuropathic pain induced by damage to large nerves or the spinal cord, suggesting intercostal nerve damage as the primary cause of postthoracotomy pain. However, no report has established a relationship between a specific damaged tissue and postthoracotomy pain.…”

Section: Discussionmentioning

confidence: 70%

A rat model of postthoracotomy pain: behavioural and spinal cord NK-1 receptor assessment

Nara

Saito

Obata

et al. 2001

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To develop a new rat model of postthoracotomy pain for investigating its mechanisms and clarifying neurochemical changes.M Me et th ho od ds s: : Male Wistar rats were randomly assigned to three groups that underwent either fourth and fifth intercostal nerve ligation, cutting of the fourth and fifth ribs, or a sham operation in which only pleura was cut. For behavioural response assessment during the following month, pinch and touch were used as mechanical stimuli, and acetone was used as a cold thermal stimulus. In addition, 125 I-substance P autoradiography was used to determine neurokinin (NK) receptor density in spinal cord laminae I and II at one to six weeks after surgery.R Re es su ul lt ts s: : In rats with nerve ligation, hypersensitivity to noxious and non-noxious stimuli continued throughout the month. The mirror phenomenon was observed. The lowest threshold was obtained in the dorsomedial portion of the T4 dermatome on the side of surgery. In rats with rib cutting, a lowered threshold to noxious and non-noxious stimuli was observed for two weeks. In rats with sham operations, hypersensitivity was seen only at postoperative day one. NK-1 receptor density on the side of operation increased significantly in rats with nerve ligation from day seven to 28. Receptor density was highest on day 14 (22.97 ± 1.04 fmol·mg 1 tissue vs control, 16.22 ± 0.43), representing a 50% receptor excess on the side of ligation compared to the contralateral side.C Co on nc cl lu us si io on n: : Intercostal nerve damage induces long-term postthoracotomy pain and an increase of spinal NK-1 receptors in rats. This model may be useful for investigation of postthoracotomy pain.Objectif : Élaborer un modèle de douleur post-thoracotomie chez le rat afin den explorer les mécanismes et den préciser les changements neurochimiques.Méthode : Des rats mâles Wistar ont été répartis au hasard en trois groupes et on subi une ligature des quatrième et cinquième nerfs intercostaux, ou la section des quatrième et cinquième côtes ou une opération fictive comportant une incision de la plèvre seulement.Pendant le mois suivant, on a évalué la réponse comportementale à des stimuli mécaniques, pincement et toucher, et la sensibilité au froid avec de lacétone. De plus, une autoradiographie de la substance P réalisée avec 125 I a été utilisée pour déterminer la densité du récep-teur de neurokinine (NK) dans les lames I et II de moelle épinière de une à six semaines après lopération. Résultats :Chez les rats avec ligature des nerfs, lhypersensibilité à des stimuli nocifs ou non sest poursuivie tout au long du mois. Le «phénomène miroir» a été observé. Le seuil le plus bas a été noté dans la portion dorsomédiane du dermatome T4 du côté de la ligature. Chez les rats aux côtes sectionnées, le seuil le plus bas aux stimuli nocifs ou non a été observé pendant deux semaines. Chez les rats qui ont subi une opération fictive, lhypersensibilité na été observée que le jour suivant lintervention. La densité du récepteur NK-1 du côté de l...

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Percutaneous cryotherapy for post-thoracotomy neuralgia

Abstract: Fourteen patients had percutaneous cryotherapy for persistent post-thoracotomy neuralgia. Although a significant proportion had their condition improved, relief was temporary. However, a third felt that symptoms were exacerbated by the therapy.

Cited by 25 publications

References 2 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

Anatomical Variation in the Position of the Proximal Intercostal Nerve

A rat model of postthoracotomy pain: behavioural and spinal cord NK-1 receptor assessment

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