Ultrasound-guided percutaneous cryoneurolysis providing postoperative analgesia lasting many weeks following a single administration: a replacement for continuous peripheral nerve blocks?: a case report

Abstract

Cryoneurolysis entails using low temperatures to reversibly ablate nerves, with a subsequent analgesia duration measured in weeks or months. Previously, clinical applications for acute pain were limited because treatment originally required exposing the target nerve surgically. However, three developments have now made it possible to provide prolonged postoperative analgesia by cryoneurolysis: 1) new portable, hand-held cryoneurolysis devices, 2) ultrasound machine proliferation, and, 3) anesthesiologists trained in ultrasound-guided peripheral nerve block administration. This report is the first to describe the use of a single preoperative administration of ultrasound-guided percutaneous cryoneurolysis to provide multiple weeks of analgesia following shoulder rotator cuff repair and total knee arthroplasty. Considering the significant benefits of cryoanalgesia relative to continuous peripheral nerve blocks (e.g., lack of catheter/pump care, extremely long duration), this analgesic modality may be a practical alternative for the treatment of prolonged post-surgical pain in a select group of surgical patients.

Keywords: Cryoablation; Cryoanalgesia; Cryoneuroanalgesia; Perioperative analgesia; Postoperative analgesia.

Conflict of interest statement

Conflict of Interest: The cryoneurolysis device, probes, and nitrous oxide canisters used in these case reports were provided by the manufacturer (Myoscience, Fremont, California, United States). This company had no input into any aspect of these cases or manuscript preparation. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of this company.

Figures

Fig. 1. A portable cryoneurolytic device with a 5.5-cm, 22 gauge cryoprobe (Iovera Focused Cold Therapy, Myoscience, Freemont, CA, USA).

Fig. 2. A modern cryoneurolysis probe (“cannula”) produces extremely cold temperatures at its tip due to the Joule-Thomson effect, resulting from gas flowing from a high- to a low-pressure chamber (used with permission).