Cryoanalgesia in Patients Undergoing Nuss Repair of Pectus Excavatum: Technique Modification and Early Results.

PURPOSE: The Nuss procedure for surgical correction of pectus excavatum often causes severe postoperative pain. Cryoanalgesia of intercostal nerves is an alternative modality for pain control. We describe our modification of the cryoICE™ probe that allows for nerve ablation through the ipsilateral chest along with early results utilizing this technique. METHODS: To allow for ipsilateral nerve ablation, a 20-French chest tube was cut and secured to the cryoICE probe, thus providing insulation for the malleable end of the probe. A 3-year retrospective review of patients undergoing Nuss repair at our institution was performed. Patients who received cryoanalgesia (cryo, n = 6) were compared with a historical control cohort who did not receive cryoanalgesia (nocryo, n = 13) during Nuss repair. Hospital length of stay, postoperative narcotic requirement (PNR), and highest postoperative pain score were collected. RESULTS: Both cohorts were similar regarding age, BMI, and pectus index. The cryo group had a significantly less PNR (6.4 versus 17.9 doses, P = .05) and was discharged on average >1 day earlier than nocryo patients (3.7 versus 2.2 days, P = .01). No complications occurred in either group. CONCLUSIONS: Our technique modification simplifies previously described approaches to intercostal nerve cryoablation. Patients undergoing this adjunct benefit with less PNR and a faster discharge time.

Ethyl chloride as a cryoanalgesic in pediatrics for venipuncture.

INTRODUCTION: Ethyl chloride can be used as a cryoanalgesic, but with the availability of alternative and relatively safer topical analgesics, its use has decreased. However, it still has the advantage of being quicker to apply compared with other topical analgesics, making it ideal for use in the outpatient departments. We wanted to compare the effectiveness of ethyl chloride as an analgesic during venipuncture in children. METHODS: Venipuncture was carried out using either no analgesia (NO), ethyl chloride spray (EC), or application of the topical anesthetic Ametop (TA) on children attending the phlebotomy outpatient service by experienced pediatric phlebotomists. A pain score was recorded using either the Faces scoring system or the Faces, Legs, Activity, Cry Consolability scoring system. RESULTS: A total of 55 patients were included in the study, 18 from group EC, 18 from group TA, and 19 from group NO. Thirteen patients from both groups EC and TA and 17 from group NO scored 2 or less on the pain scores. DISCUSSION: The use of ethyl chloride was as effective as topical anesthetics in preventing distress to children in venipuncture. However, in the appropriate situations, the use of NO could also be comfortable to the child if venipuncture was done by specialist pediatric phlebotomists.

Topical cryoanesthesia for the relief of pain caused by steroid injections used to treat hypertrophic scars and keloids.

Intralesional steroid injections are the standard treatment for hypertrophic scars and keloids. The procedure is, however, quite painful and is unpopular with patients because of this. Topical application of anesthetic creams, such as Ametop gel (tetracaine) and EMLA cream (lidocaine and prilocaine), has limited efficacy because of poor drug penetration. The onset of the analgesic effect is also slow, which means that the use of topical anesthetics is time-consuming in clinical practice.We hypothesized that a commercially available cryotip could be used to provide fast-acting topical cryoanesthesia that would reduce the pain associated with steroid injections.Thirty patients with hypertrophic scars or keloids were enrolled in the study. Scars were injected with the steroid, triamcinolone acetonide, with or without prior application of the cryotip (-10 °C) for 15 seconds. The degree of pain was evaluated in each case using the visual analogue scale (VAS) and the verbal descriptor scale (VDS), together with any side-effects caused by application of the cryotip.The VAS pain scores showed a statistically significant (P < .01) difference between the pretreated and the control scars (pain scores 7.87 ±â€Š1.31 and 2.7 ±â€Š1.37, respectively). The VDS pain scores also showed a statistically significant (P < .01) difference between the pretreated and the control scars. And its average scores were 7.89 ±â€Š0.32 and 2.68 ±â€Š0.25, respectively.Application of the cryotip before injection could provide a rapid and effective means of reducing the pain associated with steroid injections. Painless would result in better therapeutic effect.

Providing pain relief for laser resurfacing: effectiveness of the CoolAnalgesia device.

Laser resurfacing is a painful procedure, and is therefore usually carried out under general anaesthetic or local anaesthetic with sedation. However, the small but significant risk of adverse events from either of these methods has resulted in an effort to develop other methods of controlling the pain associated with the use of lasers. This trial describes of the use of a cooling device (the CoolAnalgesia device) with a carbon dioxide laser. The only anaesthetic used was a eutectic mixture of lidocaine anaesthetic (EMLA) applied as a cream to the face at least 60 min prior to the procedure. Twenty consecutive patients attending two laser centres for facial resurfacing were recruited. Each patient was asked to assess the level of pain on a visual analogue scale from 1-10 every 2 min during lasering. Only one of the patients had a mean pain score for the duration of the treatment of above five, four patients recorded a pain score of above five at some stage during their treatment, but none requested that the treatment be stopped. It would appear that the CoolAnalgesia device in combination with EMLA cream provides a level of anaesthesia sufficient to allow laser resurfacing without the use of local anaesthetic injections or intra-venous agents.