In this engaging session from the 12th Annual Update Course in Pediatric Surgery, Dr. Timothy Lautz explores the expanding role of cryoanalgesia in pediatric thoracotomy beyond pectus repair. As more institutions embrace this technique, Dr. Lautz breaks down its use, safety, and clinical advantages for thoracotomy pain control.
Key Highlights:
Beyond Pectus Repair: While commonly used for pectus excavatum, cryoanalgesia is now being applied in thoracotomy cases to improve postoperative recovery.
How It Works: Temporary nerve blockade is achieved by freezing the intercostal nerves, reducing or eliminating the need for epidurals and long-term opioids.
Safety & Recovery: The procedure is safe, repeatable, and allows even small children to benefit from reduced pain and faster recovery timelines.
Clinical Implementation: Dr. Lautz offers insight into when and how his team applies cryo, including tips for technique, timing, and avoiding complications.
This talk underscores the value of multidisciplinary collaboration and highlights how surgical innovation can reduce patient discomfort and streamline recovery.
Type: video · 4 min · posted 2025-06-18 Canonical: https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574 ## Chapters - [0:01](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=1) Introduction and Course Context - [0:54](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=54) Cryoanalgesia Mechanism and Anatomy - [1:31](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=91) Current Practice Patterns and Advantages - [2:05](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=125) Technical Application and Tips - [3:09](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=189) Clinical Outcomes and Data - [3:59](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=239) Summary and Conclusion ## Statements - "Cryoanalgesia temporarily blocks nerve conduction along peripheral nerve pathways by freezing the affected nerve" — Lizzie Lee (clinical) [1:02](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=62) - "The freeze causes axonal degeneration while the epineurium stays intact" — Timothy Lotz (clinical) [1:19](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=79) - "When fibrous outer neural structures remain intact, axons can regenerate in 4 to 6 weeks" — Lizzie Lee (clinical) [1:25](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=85) - "Very few people do intercostal nerve cryoablation for pain control during thoracotomy, based on poll results from combined live and virtual audience" — Lizzie Lee (epidemiological) [1:39](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=99) - "Epidurals usually only give pain relief for a few days" — Lizzie Lee (clinical) [1:57](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=117) - "Cryoanalgesia can help with pain control all through the recovery period" — Lizzie Lee (clinical) [1:57](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=117) - "The team has done 300 thoracotomy cases with cryoanalgesia and seen great results" — Timothy Lotz (epidemiological) [2:10](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=130) - "Cryoanalgesia is applied 1 to 2 levels above and below the thoracotomy" — Timothy Lotz (clinical) [2:17](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=137) - "At T10 level or lower, you can start to get pseudohernias on the abdominal wall from affecting the motor branches" — Lizzie Lee (clinical) [2:23](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=143) - "60 seconds of freeze time is sufficient" — Timothy Lotz (clinical) [2:32](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=152) - "Temporary intercostal nerve blocks are used to help for the first 8 hours before cryoanalgesia sets in" — Timothy Lotz (clinical) [2:33](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=153) - "Standard probe is used down to age 3, with cases done in kids as young as 18 months" — Timothy Lotz (clinical) [2:39](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=159) - "A cardiac probe is used for ablations in smaller children" — Lizzie Lee (clinical) [2:44](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=164) - "In smaller children, retractors are used to hold skin away because there is not much chest wall musculature and skin freeze could occur" — Timothy Lotz (clinical) [2:52](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=172) - "The newest probe has shaft insulation that only gets to room temperature, eliminating skin freeze risk because only the probe tip gets cold" — Lizzie Lee (clinical) [2:58](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=178) - "Benefits include no epidural, no Foley catheter, and patients getting up and moving right away" — Timothy Lotz (clinical) [3:09](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=189) - "Pulmonary toilet has been great with cryoanalgesia" — Timothy Lotz (clinical) [3:13](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=193) - "Comparison in the group showed a 2 to 3-fold reduction in narcotic use during hospitalization" — Timothy Lotz (epidemiological) [3:15](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=195) - "Kids were sent home without any narcotic prescriptions" — Lizzie Lee (clinical) [3:21](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=201) - "You don't have to wait for a regional team when using cryoanalgesia" — Lizzie Lee (clinical) [3:24](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=204) - "The study compared results to a routine group with IV pain medication only and to those with regional block" — Timothy Lotz (epidemiological) [3:29](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=209) - "The study included 23 thoracotomies with cryoanalgesia" — Timothy Lotz (epidemiological) [3:37](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=217) - "The cryoablation group used dramatically fewer oral morphine equivalents during hospital stay compared to the regional nerve block group" — Lizzie Lee (epidemiological) [3:40](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=220) - "Cryoanalgesia group used 137 oral morphine equivalents versus 533 in the comparison group" — Timothy Lotz (epidemiological) [3:50](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=230) - "The team uses cryoanalgesia all the time for thoracotomies, other than neonatal thoracotomies" — Timothy Lotz (clinical) [3:50](https://library.globalcastmd.com/watch/update-course-rewind-part-1-non-pectus-uses-of-cryoanalgesia-2024-10574?t=230) ## Transcript Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello pediatric surgery family. I'm Lizzie Lee from Cincinnati Children's Hospital Medical Center. In this video series, we'll be recapping the sessions and sharing the key highlights from our 12th annual update course in pediatric surgery, which was held in August 2024. This year we introduced a new approach to classify practice changing ideas at our update course. Presentations now fall into three categories green circles for established practices, blue squares for promising newer practices, and black diamonds for early adopter practices only. Today we are talking about cryoanalgesia uses outside of pectus repair with pediatric surgeon Doctor Timothy Lotz from Blurry Children's Hospital. This topic falls into the blue category as a newer approach. We're gonna talk about some of the basics, some of the benefits in thoracotomy, and the novel uses, especially if you start to use percutaneous applications of cryo. Cryoanalgesia is a minimally invasive procedure to alleviate pain during surgery. It temporarily blocks nerve conduction along peripheral nerve pathways. Freezing the affected nerve gives pain relief. You wanna stay far enough posterior, but you also want to stay off of the sympathetic chains so you can visualize this very clearly. You're getting axonal degeneration by the freeze, but at the same time, the epineurium is staying intact. When you leave the fibrous outer neural structures intact, the axons can regenerate in 4 to 6 weeks. Let's look at our first poll question. What is your preferred pain control modality when doing a thoracotomy for pulmonary metastasis? The poll results from the combined live and virtual audience showed that very few people do intercostal nerve cryoablation for pain control during a thoracotomy. I'm hoping I can convince you that cryo is a really good tool here. Epidurals are wonderful, but it is an invasive procedure that takes time, and you may or may not be leaving it fully. Epidurals usually only give pain relief for a few days, whereas cryo analgesia can help with pain control all through the recovery period. We're doing a muscle sparing thoracotomy and then an open direct application of the cryoprobe. We've done 300 attracure cases, and we've seen great results. Here are some tips and tricks for using the cryoprobe for thoracotomies. We're going 1 to 2 levels above and below the thoracotomy. You have to be a little bit careful about getting too low. Once you get to the T10 level or lower, you can start to get some pseudohernias on the abdominal wall from affecting the motor branches there. 60 seconds is sufficient. We also do temporary intercostal nerve blocks to help for those 1st 8 hours before it sets in. We're using the standard probe down to age 3. We've done kids down to about 18 months. There's a cardiac probe that they use for some of their ablations. In smaller children, you have to be really careful and use a smaller probe. We get a retractor in and hold the skin away because there's not a lot of chest wall musculature and you could get some skin freeze. With the newest probe, that problem is totally eliminated because the shaft insulation only gets to room temperature, so you can touch the lung and you can touch the skin. The only thing that gets cold is the probe. So the benefits is there's no epidural, there's no Foley, they're getting up and moving right away. The pulmonary toilet has been great. We did a comparison in our group and we saw a 2 to 3-fold reduction in narcotic use during the hospitalization. They were able to send these kids home without any narcotic. Prescriptions and another benefit was that you don't have to wait for a regional team. This was our data. We compared what their results were compared to all of the routine group, which was just IV pain med only, but also compared to those that had regional block. In this study, we had 23 thoracotomies who had cryo. When compared with the group that only used regional nerve blocks, the intercostal nerve cryoablation group used dramatically fewer oral morphine equivalents during their hospital stay. So 137 versus 533, we're using a lot less opioid, other than our neonatal thoracotomies, and we've gone to using this all the time. In summary, when performing thoracotomies, cryoanalgesia is a less invasive alternative to epidurals. It can reduce opioid use, decrease patients' pain scores, and expedite patient recovery. This concludes part one of our video on cryoanalgesia uses outside of pectus repair. To watch part two, click on the link below. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai