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

      case-report

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          Abstract

          Background

          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.

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          Most cited references9

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          The morbidity and mortality of rib fractures.

          N. Agarwal, Alan D. Ziegler (1994)
          The incidence of rib fractures secondary to trauma has not been clearly reported. Of the 7147 patients seen by our trauma service from January 1987 to June 1992, 711 (10%) had rib fractures. Among the patients with rib fractures, 84 (12%) died, 670 (94%) had associated injuries, 274 (32%) had a hemothorax or pneumothorax, and 187 (26%) had a lung contusion. Fifty-five percent of the patients required an immediate operation or admission to the intensive care unit. Thirty-five percent of the patients required discharge to an extended care facility and 35% developed a pulmonary complication. We conclude that rib fractures are a marker of severe injury in which (1) 12% will die because of their injuries, (2) more than 90% will have associated injuries, (3) one half will require operative and ICU care, (4) one third will develop pulmonary complications, and (5) one third will require discharge to an extended care facility.
          Article 0 comments Cited 63 times – based on 0 reviews     Review now
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            Cryoanalgesia in interventional pain management.

            Andrea Trescot (2003)
            Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions. The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact. Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis. This review describes historical concepts, physics and equipment, various clinical aspects, along with technical features, indications and contraindications, with clinical description of multiple conditions amenable to cryoanalgesia in interventional pain management settings.
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              Analgesic Choice in Management of Rib Fractures: Paravertebral Block or Epidural Analgesia?

              Mahdi Malekpour, Ammar Hashmi, James Dove … (2017)
              Rib fractures are commonly encountered in the setting of trauma. The aim of this study was to assess the association between the clinical outcome of rib fracture and epidural analgesia (EA) versus paravertebral block (PVB) using the National Trauma Data Bank (NTDB).
              Article 0 comments Cited 9 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean J Anesthesiol
                Journal ID (iso-abbrev): Korean J Anesthesiol
                Journal ID (publisher-id): KJA
                Title: Korean Journal of Anesthesiology
                Publisher: Korean Society of Anesthesiologists
                ISSN (Print): 2005-6419
                ISSN (Electronic): 2005-7563
                Publication date (Print): October 2020
                Publication date (Electronic): 5 November 2019
                Volume: 73
                Issue: 5
                Pages: 455-459
                Affiliations
                [1 ]Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
                [2 ]Department of Surgery, University of California, San Diego, La Jolla, CA, USA
                Author notes
                Corresponding author: John J. Finneran IV, Departments of Anesthesiology, University of California, 200 West Arbor Drive MC 8770 San Diego, CA 92103, USA Tel: +1-408-307-3004 Fax: +1-619-543-6162 Email: jfinneran@ 123456ucsd.edu
                Author information
                http://orcid.org/0000-0002-0955-155X
                http://orcid.org/0000-0003-4443-0021
                http://orcid.org/0000-0003-2196-6288
                http://orcid.org/0000-0002-7299-453X
                http://orcid.org/0000-0003-4088-2418
                http://orcid.org/0000-0002-0215-5327
                http://orcid.org/0000-0002-6144-3273
                Article
                Publisher ID: kja-19395
                DOI: 10.4097/kja.19395
                PMC ID: 7533180
                PubMed ID: 31684715
                SO-VID: 622ba5fe-f30b-4989-bd85-d4f46121fe73
                Copyright © Copyright © The Korean Society of Anesthesiologists, 2020
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 September 2019
                Date accepted : 4 November 2019
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: analgesia,cryoablation,nerve block,rib fracture,trauma,ultrasound
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: analgesia, cryoablation, nerve block, rib fracture, trauma, ultrasound

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