Update Course Rewind: Part 1 Non-Pectus Uses of Cryoanalgesia 2024
With Dr. Timothy Lotz · hosted by Dr. Lizzie Lee · StayCurrentMD
Part of
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What the experts said
Cryoanalgesia temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve
The freeze causes axonal degeneration while the epineurium stays intact
When fibrous outer neural structures remain intact, axons can regenerate in 4 to 6 weeks
Very few people do intercostal nerve cryoablation for pain control during thoracotomy, based on poll results from combined live and virtual audience
Epidurals usually only give pain relief for a few days
Cryoanalgesia can help with pain control all through the recovery period
The team has done 300 thoracotomy cases with cryoanalgesia and seen great results
Cryoanalgesia is applied 1 to 2 levels above and below the thoracotomy
At T10 level or lower, you can start to get pseudohernias on the abdominal wall from affecting the motor branches
60 seconds of freeze time is sufficient
Temporary intercostal nerve blocks are used to help for the first 8 hours before cryoanalgesia sets in
Standard probe is used down to age 3, with cases done in kids as young as 18 months
A cardiac probe is used for ablations in smaller children
In smaller children, retractors are used to hold skin away because there is not much chest wall musculature and skin freeze could occur
The newest probe has shaft insulation that only gets to room temperature, eliminating skin freeze risk because only the probe tip gets cold
Benefits include no epidural, no Foley catheter, and patients getting up and moving right away
Pulmonary toilet has been great with cryoanalgesia
Comparison in the group showed a 2 to 3-fold reduction in narcotic use during hospitalization
Kids were sent home without any narcotic prescriptions
You don't have to wait for a regional team when using cryoanalgesia
The study compared results to a routine group with IV pain medication only and to those with regional block
The study included 23 thoracotomies with cryoanalgesia
The cryoablation group used dramatically fewer oral morphine equivalents during hospital stay compared to the regional nerve block group
Cryoanalgesia group used 137 oral morphine equivalents versus 533 in the comparison group
The team uses cryoanalgesia all the time for thoracotomies, other than neonatal thoracotomies