Update Course Rewind: Cryoanalgesia in Pectus Cases 2024

Cryoanalgesia is a minimally invasive procedure to repair pectus excavatum or alleviate pain during surgery on the chest wall that temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve

The freeze point is in the posterior axillary line, 4 centimeters from the vertebral column

With the original cryoprobe, it's a 2-minute freeze cycle

Cryoablation is performed from T3 to T8, although most of the literature is just to T7

Subpleural injection with 0.25% marcaine with epinephrine works immediately, as opposed to the 8 to 10 hour delay with the cryo nerve block

Subpleural injection takes only 15 seconds per interspace

50% of the update course audience has never used cryoanalgesia

About 40% of the update course responders answered that cost is the main reason they don't use cryoanalgesia

Doing T3 to T8 bilaterally with the new probe saves almost 30 minutes

The new probe tip gets down to temperature about 20 seconds faster

The freeze cycle with the new probe is 90 seconds instead of 2 minutes

The new probe shaft only reaches room temperature so it can touch the lung

A Chicago study showed that a 1 minute freeze cycle was just as effective as a 2 minute freeze cycle for nerve blocks

The Chicago study did not measure pain scores or compare the 1 minute freeze cycle directly to 2-minute freeze cycles

A new 10 millimeter probe with a 60 second freeze cycle is coming out on October 1st

There is a risk of pneumothorax from the lung tearing after inadvertent adhesion to the cryoprobe

The double lumen endotracheal tube helps minimize pneumothorax risk by deflating the lung and maximizing working space so that the cryoprobe does not touch the lung

A major advantage of the double lumen tube over the single lumen tube is that it helps prevent the nerve block from being done too far anteriorly, which will make the nerve block ineffective

Doctor Sung Kim did a cadaver study at UCSF showing that 18% of the lateral cutaneous branch nerves are posterior to the mid axillary line

Doctor Kim showed in the study that there is a large collateral branch of the intercostal nerve that runs along the top of the nerve, separate from the main intercostal branch on the bottom of the nerve

Doctor Defiori has done the dual freeze point technique in 20 patients anecdotally

The peak pain scores have dropped from about 5 to about 3 with the dual freeze point technique

98% of Doctor Defiori's patients go home the next day

In the UCSF study with 2 freeze points per interspace on 22 patients, the length of stay decreased from 2 days to 1 day

9 out of the 22 patients in the UCSF dual freeze point study reported pain scores of 0

Cryoanalgesia controls pain and decreases hospital length stay with few short-term complications