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Sahlya Djebbar, Ignacio M Rossi, Ronald S Adler
The real-time nature of ultrasound makes it ideally suited to provide guidance for a variety of musculoskeletal interventional procedures involving peripheral nerves. Continuous observation of the needle ensures proper placement and allows continuous monitoring when performing localized ablative therapy and therefore more accurate positioning of a cryoprobe, use of smaller needles, as well as access to small structures. We describe our experience performing cryoablative procedures. Patients undergoing cryoneurolysis have largely reported varying degrees of long-term pain relief and improvement in function; no serious complications have yet been identified...
November 2016: Seminars in Musculoskeletal Radiology
Brian M Ilfeld
A continuous peripheral nerve block (CPNB) consists of a percutaneously inserted catheter with its tip adjacent to a target nerve/plexus through which local anesthetic may be administered, providing a prolonged block that may be titrated to the desired effect. In the decades after its first report in 1946, a plethora of data relating to CPNB was published, much of which was examined in a 2011 Anesthesia & Analgesia article. The current update is an evidence-based review of the CPNB literature published in the interim...
January 2017: Anesthesia and Analgesia
Andrei Sdrulla, Grace Chen
Neuropathic pain is "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system". The prevalence of neuropathic pain ranges from 7 to 11% of the population and minimally invasive procedures have been used to both diagnose and treat neuropathic pain. Diagnostic procedures consist of nerve blocks aimed to isolate the peripheral nerve implicated, whereas therapeutic interventions either modify or destroy nerve function. Procedures that modify how nerves function include epidural steroid injections, peripheral nerve blocks and sympathetic nerve blocks...
April 2016: Pain Management
Yongchun Li, Meixi Xu, Yaoxuan He, Shengquan Ye, Hongsheng Lin, Fu Li, Wei Li, Junye Wang
OBJECTIVE: To investigate the analgesic efficacy and safety of intercostal nerve cryoanalgesia after video-assisted thoracoscopic surgery (VATS). METHODS: This was a prospective randomized controlled study. From May 2014 to April 2015, 80 patients who would undergoing selective surgery performed by the same surgeon team were chosen, and were randomly divided into cryoanalgesia group and intravenous analgesia group by a random number table. Visual analogue scale (VAS) at resting and movement were measured on postoperative 4 h, 1 d, 2 d, 3 d, and the amount of supplemental morphine use and adverse reactions were recorded; plasma concentration of cortisol, blood glucose, C-reactive protein (CRP) and interleukin-6 (IL-6) were detected on preoperative and postoperative 4 h,1 d,2 d...
October 13, 2015: Zhonghua Yi Xue za Zhi [Chinese medical journal]
N Pucks, A Thomas, M J Hallam, V Venables, C Neville, C Nduka
INTRODUCTION: Botulinum toxin injections are an effective, well-established treatment to manage synkinesis secondary to chronic facial palsy, but they entail painful injections at multiple sites on the face up to four times per year. Cutaneous cooling has long been recognised to provide an analgesic effect for cutaneous procedures, but evidence to date has been anecdotal or weak. This randomised controlled trial aims to assess the analgesic efficacy of cutaneous cooling using a cold gel pack versus a room-temperature Control...
December 2015: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Chong H Kim, Wayne Hu, Jeff Gao, Kristin Dragan, Thomas Whealton, Christina Julian
BACKGROUND: Treatment of occipital neuralgia (ON) can be complex, though many treatment options exist. Cryoablation (CA) is an interventional modality that has been used successfully in chronic neuropathic conditions and is one such option. OBJECTIVE: To study and evaluate the efficacy and safety of cryoablation for treatment of ON. STUDY DESIGN: Retrospective evaluation. SETTING: Academic university-based pain management center...
May 2015: Pain Physician
Martina Bellini, Massimo Barbieri
BACKGROUND: Cryoanalgesia, also known as cryoneuroablation or cryoneurolysis, is a specialized technique for providing long-term pain relief. METHODS: There are presented retrospective data on pain relief and changes in function after cryoanalgesia techniques: we describe the effect of this procedure on articular facet syndromes, sacroiliac pain and knee pain. We reviewed records of 18 patients with articular lumbar facet pain, knee pain and sacroiliac pain. RESULTS: Both the visual analog scale and the Patient's global impression of change scale showed an increase in patients' satisfaction already at 1 month after cryoablation, with the best scores after three months...
2015: Anaesthesiology Intensive Therapy
Roberto Pinto Coelho, Ricardo Helio Biaggi, Rodrigo Jorge, Maria de Lourdes Veronese Rodrigues, André Messias
PURPOSE: To compare the analgesic efficacy of 2 types of anesthetic techniques-topical and topical associated with cryoanalgesia-during cataract surgery. SETTING: Department of Ophthalmology, University of São Paulo, Ribeirão Preto, Brazil. DESIGN: Prospective randomized study. METHODS: Patients with symmetrical bilateral cataract had phacoemulsification with the use of an intraocular irrigation solution at room temperature in 1 eye and a cold (4°C) solution in the contralateral eye (Group 2)...
April 2015: Journal of Cataract and Refractive Surgery
Jeffrey M Haynes
BACKGROUND: Arterial puncture can be a painful procedure for many patients. This study investigates whether precooling of a puncture site with ice can reduce the pain associated with arterial puncture. METHODS: This was a stratified randomized controlled trial of a convenience sample of out-patients with a physician order for an arterial blood gas (ABG) test. The intervention group had a plastic bag of ice applied to their wrists for 3 min before drawing an ABG sample from the radial artery...
January 2015: Respiratory Care
Yu-Feng Ba, Xiao-Dong Li, Xiaofei Zhang, Zhong-Hua Ning, Hanze Zhang, Yi-Ning Liu, Shan-Hong He, Yu Zhu, Chang-Sheng Li, Quan-Hui Wang, Yin Li
This study was designed to compare the analgesic effects of cryoanalgesia and parecoxib in lung cancer patients after lobectomy. A total of 178 lung cancer patients awaiting large-sized lobectomy were enrolled in the study. The patients were randomly divided into Group A (intercostal nerve cryoanalgesia) and Group B (parecoxib). The analgesic and adverse effects were compared between the two groups. The pain score of Group A was significantly lower than that of Group B (P < 0.05). The patients in Group A used significantly less morphine than those in Group B (P < 0...
October 2015: Surgery Today
S R Humble, A J Dalton, L Li
BACKGROUND: Perioperative neuropathic pain is under-recognized and often undertreated. Chronic pain may develop after any routine surgery, but it can have a far greater incidence after amputation, thoracotomy or mastectomy. The peak noxious barrage due to the neural trauma associated with these operations may be reduced in the perioperative period with the potential to reduce the risk of chronic pain. DATABASES AND DATA TREATMENT: A systematic review of the evidence for perioperative interventions reducing acute and chronic pain associated with amputation, mastectomy or thoracotomy...
April 2015: European Journal of Pain: EJP
Apostolos Gogakos, Dimitrios Paliouras, Fotios Chatzinikolaou, Nikolaos Barbetakis
No abstract text is available yet for this article.
February 2014: Interactive Cardiovascular and Thoracic Surgery
Diem Phuc T Banh, Pablo M Moujan, Quazi Haque, Tae-Hyung Han
A peripheral nerve stimulator (PNS) can be an alternative for long-term pain relief refractory to conventional therapeutic modalities. We present a case of chronic incapacitating ilioinguinal neuralgia, which was successfully managed with permanent implantation of a peripheral nerve stimulator. A 26-year-old active duty African American man was referred to the University Pain Clinic with left ilioinguinal neuralgia due to shrapnel injury during his military service 6 years prior to his visit. Most of the shrapnel were surgically removed, but the patient subsequently developed left lower abdominal pain...
November 2013: Pain Physician
Mustafa Khanbhai, Kok Hooi Yap, Shaza Mohamed, Joel Dunning
A best evidence topic was written according to a structured protocol. The question addressed was whether cryoanalgesia improves post-thoracotomy pain and recovery. Twelve articles were identified that provided the best evidence to answer the question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Reported measures were pain scores, additional opiate requirements, incidence of hypoesthesia and change in lung function. Half of the articles reviewed failed to demonstrate superiority of cryoanalgesia over other pain relief methods; however, additional opiate requirements were reduced in patients receiving cryoanalgesia...
February 2014: Interactive Cardiovascular and Thoracic Surgery
Nadine Matthias, Mary A Robinson, Robyn Crook, Cynthia R Lockworth, Bradford S Goodwin
Tail-tip biopsy for genotyping of genetically modified mice older than 21 d typically is performed by using isoflurane anesthesia. Isoflurane-induced changes in behavior and metabolism can result in unexpected complications and death. We investigated whether cryoanalgesia by using ethylene chloride spray would be an effective local anesthetic for tail-tip biopsies in mice. C57BL/6J mice were allocated randomly into 4 groups (n = 10 each) to receive isoflurane anesthesia with tail biopsy, ethylene chloride spray on the tip of the tail before biopsy, ethylene chloride spray without biopsy, or no treatment...
March 2013: Journal of the American Association for Laboratory Animal Science: JAALAS
Evangelos Sepsas, Panagiotis Misthos, Maria Anagnostopulu, Olga Toparlaki, Gregorios Voyagis, Stamatios Kakaris
OBJECTIVES: Patients undergoing thoracotomy were studied to compare the effects of cryoanalgesia, combined with intravenous patient-controlled analgesia (IVPCA), against IVPCA alone during the four days following surgery. METHODS: Fifty patients were randomized into two groups: an IVPCA group (n = 25) and an IVPCA-cryo group (n = 25). Subjective pain intensity was assessed on a verbal analogue scale at rest and during coughing. The intensity and the incidence of post-thoracotomy pain, numbness, epigastric distension and/or back pain, the analgesic requirements, as well as the blood gas values and respiratory function tests were evaluated up to the second postoperative (postop) month...
June 2013: Interactive Cardiovascular and Thoracic Surgery
Albert A Moesker, Helen W Karl, Andrea M Trescot
The pathophysiology of phantom limb pain (PLP) is multifactorial. It probably starts in the periphery and is amplified and modified in the central nervous system. A small group of patients with PLP were questioned as to the portion of the phantom limb affected by pain (e.g., "great toe," "thumb"). In the stump, the corresponding amputated nerve was located with a nerve stimulator. With correct placement and stimulation, the PLP could then be reproduced or exacerbated. A small dose of local anesthesia was then injected, resulting in the disappearance of the PLP...
January 2014: Pain Practice: the Official Journal of World Institute of Pain
Qiang Lu, Yong Han, Wei Cao, Jie Lei, Yi Wan, Fang Zhao, Lijun Huang, Xiaofei Li
OBJECTIVES: Oesophagectomy is at present considered to be the optimal curative treatment for patients with severe oesophageal disease. Postoperative pain, both acute and chronic, plays a significant role in the quality of life for post-oesophagectomy patients. The present study compared the effects of two methods-application of a non-divided intercostal muscle flap (NIMF) and intercostal nerve cryoanalgesia (INC) treatment-in reducing neuropathic pain in post-oesophagectomy patients. METHODS: From June 2009 to June 2010, a total of 160 patients who underwent posterolateral thoracotomy and oesophagectomy were subsequently recruited to our study and divided into NIMF groups and INC groups at random...
March 2013: European Journal of Cardio-thoracic Surgery
Mohammed A Al Shahwan
BACKGROUND: Pain associated with the infiltration of local anesthesia is attributed to the acidity of the solution. Buffering with sodium bicarbonate has been used widely to reduce this affect. Growing evidence supports skin cooling (cryoanalgesia) as a measure to reduce infiltration pain. OBJECTIVE: To compare the effect of 1% lidocaine-epinephrine [1:100,000] buffered with sodium bicarbonate with skin cooling for 2 minutes with ice in reducing the pain of infiltration of anesthetic solution...
October 2012: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
Ellen E Rhame, Alexander F Debonet, Thomas T Simopoulos
The recurrent pain of a neuroma following surgical excision and burial of nerve endings can be clinically challenging to manage. Cryoanalgesia in conjunction with ultrasound guidance was used successfully to manage this type of pain. Furthermore, ultrasound provided visualization of the cryolesions, as well as the relationships of the ice ball to the surrounding tissue. Following the completion of the freeze cycle, the tissue can be monitored for return to its usual morphology during the thaw period.
2011: Case Reports in Anesthesiology
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