Ultrasound-guided percutaneous intercostal nerve cryoneurolysis for analgesia following traumatic rib fracture -a case series

John J Finneran Iv, Rodney A Gabriel, Matthew W Swisher, Allison E Berndtson, Laura N Godat, Todd W Costantini, Brian M Ilfeld, John J Finneran Iv, Rodney A Gabriel, Matthew W Swisher, Allison E Berndtson, Laura N Godat, Todd W Costantini, Brian M Ilfeld

Abstract

Backgruond: Rib fractures are a common injury in trauma patients and account for significant morbidity and mortality within this population. Local anesthetic-based nerve blocks have been demonstrated to provide significant pain relief and reduce complications. However, the analgesia provided by these blocks is limited to hours for single injection blocks or days for continuous infusions, while the duration of this pain often lasts weeks.

Case: This case series describes five patients with rib fractures whose pain was successfully treated with cryoneurolysis.

Conclusions: Ultrasound-guided percutaneous cryoneurolysis is a modality that has the potential to provide analgesia matching the duration of pain following rib fractures.

Keywords: Analgesia; Cryoablation; Nerve block; Rib fracture; Trauma; Ultrasound.

Conflict of interest statement

Conflicts of Interest

John J. Finneran (Dr. Finneran’s institution has received funding and/or product for his research from Myoscience, Epimed, Ferrosan Medical, and SPR Therapeutics)

Rodney A. Gabriel (Dr. Gabriel’s institution has received funding and/or product for his research from Myoscience, Epimed, Infutronics, Ferrosan Medical, and SPR Therapeutics)

Matthew W. Swisher (Dr. Swisher’s institution has received funding and/or product for his research from Myoscience, Epimed, Ferrosan Medical, and SPR Therapeutics)

Allison E. Berndtson (Dr. Berndtson’s institution has received product used in this report from Myoscience and Epimed)

Laura N. Godat (Dr. Godat’s institution has received product used in this report from Myoscience and Epimed)

Todd W. Costantini (Dr. Costantini’s institution has received product used in this report from Myoscience and Epimed)

Brian M. Ilfeld (Dr. Ilfeld’s institution has received funding and/or product for his research from Myoscience, Epimed, Infutronics, Ferrosan Medical, Heron Pharmaceuticals, and SPR Therapeutics)

Figures

Fig. 1.
Fig. 1.
Ultrasound-guided percutaneous cryoneurolysis. (A) Parasagittal ultrasound view of T5–T8 intercostal nerves prior to cryoneurolysis, (B) Labeled anatomy of image A, (C) Parasagittal ultrasound view of cryoneurolysis of T7 intercostal nerve, (D) Labeled anatomy of image C. Cyan circle indicates area of ice ball created from cryoneurolysis, white line: trajectory of cryoneurolysis probe.

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