Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024

Cryoablation is not limited to just thoracotomy or thoracoscopy

There are novel ways to use cryotherapy in a percutaneous approach

Cryoablation shows real benefits for rib fractures, slipping rib syndrome, and other endochondromas

Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, for floating ribs in particular, but also for false ribs

Laxity in costochondral junctions causes impingement on intercostal nerves as the ribs slip and float

Slipping rib syndrome can be the cause of chronic abdominal wall pain

Patients with slipping rib syndrome may have already had their appendix or gallbladder removed without arriving at the right diagnosis

Slipping rib syndrome is more common in teenage girls than boys

Patients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles

Patients with slipping rib syndrome really won't have a visceral type tenderness

The usual approach for patients with slipping rib syndrome is to refer them to chronic pain

Chronic pain can do an evaluation and do an intercostal block, usually a steroid as well as a long acting local

If patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound guided cryotherapy

If there's an actual response to intercostal block, the next step is to refer to surgery

IR performs ablation at just the right level or more commonly multiple levels

Cryoablation can be used intraoperatively in combination with surgery to remove the rib tips or to stabilize a slipping cartilaginous costal margin

Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores

Outcomes from using cryoablation for slipping rib syndrome included reduced narcotic use

Outcomes from using cryoablation for slipping rib syndrome included shorter length of stay in the hospital

Patients were able to resume normal activities much earlier after cryoablation for slipping rib syndrome

If you have someone come in with chest or fractures that gets stuck on a ventilator, you can do a world of good with cryoablation by anesthetizing just those intercostal spaces that are the problem

IR colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve ablation