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

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.

• Authors: Rodney A Gabriel, John J Finneran, Matthew W Swisher, Engy T Said, Jacklynn F Sztain, Bahareh Khatibi, Anne M Wallace, Ava Hosseini, Andrea M Trescot, Brian M Ilfeld
• Journal: Korean journal of anesthesiology (Korean J Anesthesiol) Vol. 73 Issue 2 Pg. 163-168 (04 2020) ISSN: 2005-7563 [Electronic] Korea (South)
• PMID: 31475505 (Publication Type: Case Reports, Research Support, Non-U.S. Gov't)

Topics

• Breast Neoplasms (diagnostic imaging, surgery)
• Cryotherapy (methods)
• Female
• Humans
• Intercostal Nerves (diagnostic imaging)
• Mastectomy (adverse effects, trends)
• Middle Aged
• Pain Management (methods)
• Pain, Postoperative (diagnostic imaging, etiology, therapy)
• Time Factors