Percutaneous cryoneurolysis enhances pain control in mastectomy patients: Study

After a mastectomy, ultrasound-guided percutaneous cryoneurolysis significantly enhanced pain relief without causing any problems or systemic adverse effects, says an article published in Anesthesiology Journal.

Untested in randomized, controlled trials, ultrasound-guided percutaneous cryoneurolysis is an analgesic treatment in which a percutaneous probe is used to reversibly destroy one or more peripheral nerves at an extremely low temperature. It can be challenging to manage pain following a mastectomy, therefore Brian Ilfeld and colleagues hypothesized that, patients receiving cryoanalgesia on postoperative day 2 would experience less severe surgically associated pain compared to patients getting just standard-of-care therapy.

Participants at one enrolling facility underwent paravertebral nerve blocks at T3 or T4 and a perineural catheter as part of their preoperative care. In a second randomized, patient- and observer-masked operation, participants had active or sham ultrasound-guided percutaneous cryoneurolysis of the ipsilateral T2 through T5 intercostal nerves. Up to the early morning of discharge, all participants had a continuous paravertebral block with ropivacaine, 0.2%. (usually postoperative day 2). On the afternoon of the second postoperative day, the average pain level was assessed using a 0–10 numeric rating scale. For a year, participants were monitored.

The key findings of this study were:

1. On the second postoperative day, patients who had undergone active cryoneurolysis (n = 31) had a median [interquartile range] pain score of 0 [0 to 1.4] as opposed to 3.0 [2.0 to 5.0] in those who had received sham (n = 29): a difference of -2.5, P 0.001.

2. Through month 12, there was evidence of greater analgesia.

3. Cryoneurolysis reduced overall opioid consumption within the first three weeks by 98%, with the active group consuming 1.5 [0 to 14] mg of oxycodone as opposed to 72 [20 to 120] mg in the sham group (P 0.001).

4. Between months one and twelve, none of the patients required oral analgesics.

5. After a year, 1 (3%) of the active individuals reported chronic pain, compared to 5 (17%) of the sham participants (P 0.001).

In conclusion, after unilateral and bilateral mastectomy, percutaneous cryoneurolysis significantly increased analgesia, decreased the need for opioids, and did so without causing any systemic problems or adverse effects. These findings recommend protocol improvements and support the viability of a bigger study in the future.

Reference:

Ilfeld, B. M., Finneran, J. J., IV, Swisher, M. W., Said, E. T., Gabriel, R. A., Sztain, J. F., Khatibi, B., Armani, A., Trescot, A., Donohue, M. C., Schaar, A., & Wallace, A. M. (2022). Preoperative Ultrasound-guided Percutaneous Cryoneurolysis for the Treatment of Pain after Mastectomy: A Randomized, Participant- and Observer-masked, Sham-controlled Study. In Anesthesiology (Vol. 137, Issue 5, pp. 529–542). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/aln.0000000000004334