Update Course Rewind: Part 1 Non-Pectus Uses of Cryoanalgesia 2024
With Dr. Timothy Lotz · hosted by Dr. Lizzie Lee · StayCurrentMD
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What the experts said
The freeze causes axonal degeneration while the epineurium stays intact
Epidurals are invasive procedures that take time and may or may not be left in fully
Dr. Lotz's group has performed 300 thoracotomy cases with cryoanalgesia and seen great results
For thoracotomies, cryoprobe should be applied 1 to 2 levels above and below the thoracotomy
60 seconds of cryoprobe application is sufficient
Temporary intercostal nerve blocks are used to help for the first 8 hours before cryoanalgesia sets in
Standard cryoprobe can be used down to age 3
Dr. Lotz's group has performed cryoanalgesia in children down to about 18 months
In smaller children, a retractor must hold skin away because limited chest wall musculature could result in skin freeze
With cryoanalgesia, patients do not need epidural or Foley catheter and can get up and move right away
Pulmonary toilet has been great with cryoanalgesia
Dr. Lotz's group saw a 2 to 3-fold reduction in narcotic use during hospitalization with cryoanalgesia
In Dr. Lotz's study, 23 thoracotomies received cryoanalgesia
Dr. Lotz's group now uses cryoanalgesia for all thoracotomies except neonatal cases
Cryoanalgesia temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve
When fibrous outer neural structures remain intact, axons can regenerate in 4 to 6 weeks
Epidurals usually only give pain relief for a few days
Cryoanalgesia can help with pain control all through the recovery period
At T10 level or lower, cryoanalgesia can cause pseudohernias on the abdominal wall from affecting motor branches
A cardiac probe used for ablations can be used in smaller children
The newest probe has shaft insulation that only reaches room temperature, eliminating skin freeze risk as only the probe tip gets cold
Patients were able to be discharged home without any narcotic prescriptions
With cryoanalgesia, surgeons do not have to wait for a regional anesthesia team
The intercostal nerve cryoablation group used 137 oral morphine equivalents during hospital stay compared to 533 in the regional nerve block group