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ANALGESIA

Ultrasound-Guided Intercostal Nerve Cryoablation

Michael G. Byas-Smith, MD^*, and Amitabh Gulati, MD

From the *Department of Anesthesiology and Section of Pain Management, Emory University School of Medicine, Atlanta, Georgia.

Address correspondence and reprint requests to Michael G. Byas-Smith, MD, Department of Anesthesiology, Emory University School of Medicine, 1364 Clifton Rd., Atlanta, GA 30322. Address e-mail to Michael.Byas-Smith{at}emory.org.

Abstract

Ultrasound technology has advanced regional anesthesia and pain management, by improving accuracy and reducing complication rates. We have successfully performed cryoablation of intercostal nerves with ultrasound guidance with no complications. Four patients with postthoracotomy pain syndrome had pain relief for at least 1 mo after selective cryoablation of intercostal nerves at the mid-axillary line. Visualizing the pleura during the procedure is the greatest benefit of using ultrasonography, especially in thin patients whose intercostal groove to pleural distance may be <0.5 cm. Although further studies are needed, we feel that this new technique should reduce the risk of pneumothorax as well as improve the success of cryoablation.

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