Korean J Anesthesiol.  2020 Apr;73(2):163-168. 10.4097/kja.19332.

Ultrasound-guided percutaneous intercostal cryoanalgesia for multiple weeks of analgesia following mastectomy: a case series

• Gabriel RA
• Finneran J
• Swisher MW
• Said ET
• Sztain JF
• Khatibi B
• Wallace AM
• Hosseini A
• Trescot AM
• Ilfeld BM

• KMID: 2501823
• DOI: http://doi.org/10.4097/kja.19332

Abstract

Background
Acute post-mastectomy pain is frequently challenging to adequately treat with local anesthetic-based regional anesthesia techniques due to its relatively long duration measured in multiple weeks. Case: We report three cases in which preoperative ultrasound-guided percutaneous intercostal nerve cryoneurolysis was performed to treat pain following mastectomy. Across all postoperative days and all three patients, the mean pain score on the numeric rating scale was 0 for each day. Similarly, no patient required any supplemental opioid analgesics during the entire postoperative period; and, no patient reported insomnia or awakenings due to pain at any time point. This was a significant improvement over historic cohorts.
Conclusions
Ultrasound-guided percutaneous cryoanalgesia is a potential novel analgesic modality for acute pain management which has a duration that better-matches mastectomy than other currently-described techniques. Appropriately powered randomized, controlled clinical trials are required to demonstrate and quantify both potential benefits and risks.

Keyword

Acute pain; Cryoneurolysis; Cryoanalgesia; Mastectomy; Regional anesthesia