Intercostal Cryoneurolysis

Abstract

Chest wall pain affects many patients following chest surgery, fractures, or malignancies, and can be very difficult to manage with normal pharmacologic agents. Intercostal ablation provides one alternative treatment modality for patients suffering from intercostal pain. Intercostal cryoneurolysis involves using extreme cold to cause Wallerian degeneration of the targeted intercostal nerve. This article reviews the patient selection, technique, and complications in the utilization of intercostal neurolysis in the treatment of intractable chest pain.

Keywords

intercostal cryoneurolysis - nerve ablation - interventional radiology - pain management

Publikationsverlauf

Artikel online veröffentlicht:
30. Juni 2022

• References

• 1 Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thorac Surg Clin 2004; 14 (03) 345-352
• 2 Saberski LR. Cryoneurolysis. In: Waldman SDB. ed. Pain Management: W.B. Saunders. 2007: 1460-1474
• 3 Cha PI, Min JG, Patil A, Choi J, Kothary NN, Forrester JD. Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review. Trauma Surg Acute Care Open 2021; 6 (01) e000690
• 4 Dekonenko C, Dorman RM, Duran Y. et al. Postoperative pain control modalities for pectus excavatum repair: a prospective observational study of cryoablation compared to results of a randomized trial of epidural vs patient-controlled analgesia. J Pediatr Surg 2020; 55 (08) 1444-1447
• 5 Yang MK, Cho CH, Kim YC. The effects of cryoanalgesia combined with thoracic epidural analgesia in patients undergoing thoracotomy. Anaesthesia 2004; 59 (11) 1073-1077
• 6 Daubié S, Pilleul F, Thivolet A. et al. Cryoneurolysis in patients with dorsal neuropathic pain secondary to tumor invasion. J Vasc Interv Radiol 2020; 31 (06) 917-924
• 7 Zhao F, Vossler J, Kaye A. A multi-institution case series of intercostal nerve cryoablation for pain control when used in conjunction with surgical stabilization of rib fractures. J Cardiothorac Trauma 2019; 4: 28
• 8 Netter FH. Thorax: lungs. In: Atlas of Human Anatomy. 2014. . Accessed October 9, 2021 at: http://www.netteranatomy.com/anatomylab/subregions.cfm?subregionID=R34&contentDir=anatomylab/contents/region/t
• 9 Abd-Elsayed A, Lee S, Jackson M. Radiofrequency ablation for treating resistant intercostal neuralgia. Ochsner J 2018; 18 (01) 91-93
• 10 Yasin J, Thimmappa N, Kaifi JT. et al. CT-guided cryoablation for post-thoracotomy pain syndrome: a retrospective analysis. Diagn Interv Radiol 2020; 26 (01) 53-57
• 11 Nelson KM, Vincent RG, Bourke RS. et al. Intraoperative intercostal nerve freezing to prevent postthoracotomy pain. Ann Thorac Surg 1974; 18 (03) 280-285
• 12 Glynn CJ, Lloyd JW, Barnard JD. Cryoanalgesia in the management of pain after thoracotomy. Thorax 1980; 35 (05) 325-327
• 13 Brynitz S, Schrøder M. Intraoperative cryolysis of intercostal nerves in thoracic surgery. Scand J Thorac Cardiovasc Surg 1986; 20 (01) 85-87
• 14 Katz J, Nelson W, Forest R, Bruce DL. Cryoanalgesia for post-thoracotomy pain. Lancet 1980; 1 (8167): 512-513
• 15 Bucerius J, Metz S, Walther T. et al. Pain is significantly reduced by cryoablation therapy in patients with lateral minithoracotomy. Ann Thorac Surg 2000; 70 (03) 1100-1104
• 16 Moore W, Kolnick D, Tan J, Yu HS. CT guided percutaneous cryoneurolysis for post thoracotomy pain syndrome: early experience and effectiveness. Acad Radiol 2010; 17 (05) 603-606
• 17 Flagel BT, Luchette FA, Reed RL. et al. Half-a-dozen ribs: the breakpoint for mortality. Surgery 2005; 138 (04) 717-723 , discussion 723–725
• 18 Marasco S, Lee G, Summerhayes R, Fitzgerald M, Bailey M. Quality of life after major trauma with multiple rib fractures. Injury 2015; 46 (01) 61-65
• 19 Finneran Iv JJ, Gabriel RA, Swisher MW. et al. Ultrasound-guided percutaneous intercostal nerve cryoneurolysis for analgesia following traumatic rib fracture -a case series. Korean J Anesthesiol 2020; 73 (05) 455-459
• 20 Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2009; 21 (01) 44-57
• 21 Keller BA, Kabagambe SK, Becker JC. et al. Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: preliminary outcomes in twenty-six cryoablation patients. J Pediatr Surg 2016; 51 (12) 2033-2038
• 22 Harbaugh CM, Johnson KN, Kein CE. et al. Comparing outcomes with thoracic epidural and intercostal nerve cryoablation after Nuss procedure. J Surg Res 2018; 231: 217-223
• 23 Graves CE, Moyer J, Zobel MJ. et al. Intraoperative intercostal nerve cryoablation during the Nuss procedure reduces length of stay and opioid requirement: a randomized clinical trial. J Pediatr Surg 2019; 54 (11) 2250-2256
• 24 Bittman RW, Peters GL, Newsome JM. et al. Percutaneous image-guided cryoneurolysis. AJR Am J Roentgenol 2018; 210 (02) 454-465