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

• Main 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
• Format: Article
• Language: English
• Published: Korean Society of Anesthesiologists 2020-04-01
• Series: Korean Journal of Anesthesiology
• Subjects: acute pain; cryoanalgesia; cryoneurolysis; mastectomy; regional anesthesia
• Online Access: http://ekja.org/upload/pdf/kja-19332.pdf

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.