The role of intercostal cryoanalgesia in post-thoracotomy analgesia

Sepsas, Evangelos; Misthos, Panagiotis; Anagnostopulu, Maria; Toparlaki, Olga; Voyagis, G. S.; Kakaris, Stamatios

doi:10.1093/icvts/ivs516

Cited by 40 publications

(34 citation statements)

References 18 publications

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“…Other uses of postoperative cryoneurolysis include as treatment for postherniorrhaphy pain [70], and postthoracotomy pain [71], .Cryoneurolysis may be an effective treatment for these pains and should be considered prior to more invasive solutions. Other indications may develop as the interest in perioperative cryoneurolysis grows.…”

Section: Postoperative Cryoneurolysismentioning

confidence: 99%

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Ilfeld

Preciado

Trescot

2016

Expert Review of Medical Devices

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Introduction: Cryoneurolysis is the direct application of low temperatures to reversibly ablate peripheral nerves to provide pain relief. Recent development of a handheld cryoneurolysis device with small gauge probes and an integrated skin warmer broadens the clinical applications to include treatment of superficial nerves, further enabling treatments for pre-operative pain, post-surgical pain, chronic pain, and muscle movement disorders. Areas covered: Cryoneurolysis is the direct application of cold temperatures to a peripheral nerve, resulting in reversible ablation due to Wallerian degeneration and nerve regeneration. Use over the last 50 years attests to a very low incidence of complications and adverse effects. Cryoprobes have traditionally been applied through a surgical incision; but, recent technical advances allow percutaneous administration. A new hand-held device is now approved for use within the United States. Cryoneurolysis has been used to treat postoperative and chronic pain states as well as spasticity. Expert commentary: Changes in the US healthcare system such as a push for the reduction of opioid use and the incorporation of Diagnostic Related Group codes, as well as recent technological advances including a handheld unit that allows for treatment of superficial nerves while protecting the skin from damage, may contribute to the resurgence of cryoneurolysis for the treatment of peripheral nerves. ARTICLE HISTORY

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Section: Postoperative Cryoneurolysismentioning

confidence: 99%

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Ilfeld

Preciado

Trescot

2016

Expert Review of Medical Devices

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“…Six trials studied the impact of cryoanalgesia in thoracotomy. Of these, two trials compared cryoanalgesia against control treatment with intravenous opioids (Gwak et al, 2004; Sepsas et al, 2013), one trial compared cryoanalgesia to epidural analgesia (Ju et al, 2008), two trials compared the effect of cryoanalgesia versus placebo in thoracotomy patients who all had epidural analgesia (Yang et al, 2004; Mustola et al, 2011) and one trial compared cryoanalgesia to non-divided intercostal muscle flap (Lu et al, 2013). Six trials examined the impact of local anaesthetic; of these, three incorporated infiltration with differing doses of ropivacaine in mastectomy (Albi-Feldzer et al, 2013; Baudry et al, 2003; Vigneau et al, 2011), one trial studied the impact of lidocaine infiltration in thoracotomy patients that already had a thoracic epidural in situ (Cerfolio et al, 2003), one trial examined the effect of intravenous lidocaine (Grigoras et al, 2012) and the remaining one assessed the impact of topical EMLA (eutectic mixture of local anaesthetic) cream in mastectomy patients (Fassoulaki et al, 2000).…”

Section: Resultsmentioning

confidence: 99%

“…In one trial of thoracotomy patients, intercostal cryoanalgesia reduced acute pain versus control therapy (no epidural; Sepsas et al, 2013). In the same trial, there was a difference in pain scores at 2 months that was statistically significant, but not clinically significant (VAS: 0.0/10 vs. 0.25/10).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy

Humble

Dalton

2014

European Journal of Pain

189

150

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BackgroundPerioperative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain.Databases and data treatmentA systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy.ResultsThirty-two randomized controlled trials met the inclusion criteria. Gabapentinoids reduced pain after mastectomy, but a single dose was ineffective for thoracotomy patients who had an epidural. Gabapentinoids were ineffective for vascular amputees with pre-existing chronic pain. Venlafaxine was associated with less chronic pain after mastectomy. Intravenous and topical lidocaine and perioperative EMLA (eutectic mixture of local anaesthetic) cream reduced the incidence of chronic pain after mastectomy, whereas local anaesthetic infiltration appeared ineffective. The majority of the trials investigating regional analgesia found it to be beneficial for chronic symptoms. Ketamine and intercostal cryoanalgesia offered no reduction in chronic pain. Total intravenous anaesthesia (TIVA) reduced the incidence of post-thoracotomy pain in one study, whereas high-dose remifentanil exacerbated chronic pain in another.ConclusionsAppropriate dose regimes of gabapentinoids, antidepressants, local anaesthetics and regional anaesthesia may potentially reduce the severity of both acute and chronic pain for patients. Ketamine was not effective at reducing chronic pain. Intercostal cryoanalgesia was not effective and has the potential to increase the risk of chronic pain. TIVA may be beneficial but the effects of opioids are unclear.

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“…The treatment is usually performed after a diagnostic procedure involving local anesthetic and a cortisone derivative and has shown at least temporary relief of symptoms. Currently, attention is focused on efficacy of cryoanalgesia in decreasing pain after thoracotomy surgery [7,8].…”

mentioning

confidence: 99%

Percutaneous cryoanalgesia in pain management: a case-series

Bellini

Barbieri²

2015

Anaesthesiol Intensive Ther

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Background: Cryoanalgesia, also known as cryoneuroablation or cryoneurolysis, is a specialized technique for providing long-term pain relief. Methods:We present here retrospective data on pain relief and changes in function after cryoanalgesia techniques: we describe the effect of this procedure on articular facet syndromes, sacroiliac pain and knee pain. Results: We reviewed the records of 18 patients with articular lumbar facet pain, knee pain and sacroiliac pain. The Visual Analog Scale and Patient's Global Impression of Change scale show satisfaction at 1 month after cryoablation, with the best scores after three months. Only three patients showed a worse condition than the first month. Conclusion: The majority of patients experienced a clinically relevant degree of pain relief and improved function following percutaneous cryoanalgesia.

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The role of intercostal cryoanalgesia in post-thoracotomy analgesia

Abstract: We suggest that cryoanalgesia be considered as a simple, safe, inexpensive, long-term form of post-thoracotomy pain relief. Cryoanalgesia effectively restores FEV1 values at the second postop month.

Cited by 40 publications

References 18 publications

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

Novel cryoneurolysis device for the treatment of sensory and motor peripheral nerves

A systematic review of therapeutic interventions to reduce acute and chronic post‐surgical pain after amputation, thoracotomy or mastectomy

Percutaneous cryoanalgesia in pain management: a case-series

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