Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research
Abstract Introduction Ultrasound-guided percutaneous cryoneurolysis provides analgesia using cold temperatures to reversibly ablate peripheral nerves. Cryoneurolysis probes pass a gas through a small internal annulus, rapidly lowering the pressure and temperature, forming an ice ball to envelope the...
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2023-03-01
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| Series: | Pain and Therapy |
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| Online Access: | https://doi.org/10.1007/s40122-023-00497-y |
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| author | Engy T. Said Brennan P. Marsh-Armstrong Seth J. Fischer Preetham J. Suresh Matthew W. Swisher Andrea M. Trescot J. David Prologo Baharin Abdullah Brian M. Ilfeld |
| author_facet | Engy T. Said Brennan P. Marsh-Armstrong Seth J. Fischer Preetham J. Suresh Matthew W. Swisher Andrea M. Trescot J. David Prologo Baharin Abdullah Brian M. Ilfeld |
| author_sort | Engy T. Said |
| collection | DOAJ |
| description | Abstract Introduction Ultrasound-guided percutaneous cryoneurolysis provides analgesia using cold temperatures to reversibly ablate peripheral nerves. Cryoneurolysis probes pass a gas through a small internal annulus, rapidly lowering the pressure and temperature, forming an ice ball to envelope the target nerve. Analgesia is compromised if a nerve is inadequately frozen, and laboratory studies suggest that pain may be paradoxically induced with a magnitude and duration in proportion with the incomplete ablation. We therefore investigated the relative effects of various factors that may contribute to the size of the ice ball and the effective cryoneurolysis zone. Methods A cryoprobe was inserted into a piece of meat, a gas was passed through for 2 min, and the resulting ice ball width (cross-section) and length (axis parallel to the probe) were measured using ultrasound, with the temperature evaluated in nine concentric locations concurrently. Results The factor with the greatest influence on ice ball size was probe gauge: in all probe types, a change from 18 to 14 increased ice ball width, length, and volume by up to 70%, 113%, and 512% respectively, with minimum internal temperature decreasing as much as from −5 to −32 °C. In contrast, alternating the type of meat (chicken, beef, pork) and the shape of the probe tip (straight, coudé) affected ice ball dimensions to a negligible degree. The ice ball dimensions and the zone of adequate temperature drop were not always correlated, and, even within a visualized ice ball, the temperature was often inadequate to induce Wallerian degeneration. Conclusions Percutaneous probe design can significantly influence the effective cryoneurolysis zone; visualizing a nerve fully encompassed in an ice ball does not guarantee adequate treatment to induce the desired Wallerian degeneration because ice forms at temperatures between 0 and −20 °C, whereas only temperatures below −20 °C induce Wallerian degeneration. The correlation between temperatures in isolated pieces of meat and perfused human tissue remains unknown, and further research to evaluate these findings in situ appears highly warranted. |
| first_indexed | 2024-03-13T10:17:39Z |
| format | Article |
| id | doaj.art-018f38cf884a43058e0322a16291e94b |
| institution | Directory Open Access Journal |
| issn | 2193-8237 2193-651X |
| language | English |
| last_indexed | 2024-03-13T10:17:39Z |
| publishDate | 2023-03-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Pain and Therapy |
| spelling | doaj.art-018f38cf884a43058e0322a16291e94b2023-05-21T11:07:46ZengAdis, Springer HealthcarePain and Therapy2193-82372193-651X2023-03-0112377178310.1007/s40122-023-00497-yRelative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future ResearchEngy T. Said0Brennan P. Marsh-Armstrong1Seth J. Fischer2Preetham J. Suresh3Matthew W. Swisher4Andrea M. Trescot5J. David Prologo6Baharin Abdullah7Brian M. Ilfeld8Department of Anesthesiology, University of California San DiegoDepartment of Medicine, University of California San DiegoDepartment of Anesthesiology, University of California San DiegoDepartment of Anesthesiology, University of California San DiegoDepartment of Anesthesiology, University of California San DiegoFlorida Pain Relief GroupDepartment of Radiology, Emory UniversityDepartment of Anesthesiology, University of California San DiegoDepartment of Anesthesiology, University of California San DiegoAbstract Introduction Ultrasound-guided percutaneous cryoneurolysis provides analgesia using cold temperatures to reversibly ablate peripheral nerves. Cryoneurolysis probes pass a gas through a small internal annulus, rapidly lowering the pressure and temperature, forming an ice ball to envelope the target nerve. Analgesia is compromised if a nerve is inadequately frozen, and laboratory studies suggest that pain may be paradoxically induced with a magnitude and duration in proportion with the incomplete ablation. We therefore investigated the relative effects of various factors that may contribute to the size of the ice ball and the effective cryoneurolysis zone. Methods A cryoprobe was inserted into a piece of meat, a gas was passed through for 2 min, and the resulting ice ball width (cross-section) and length (axis parallel to the probe) were measured using ultrasound, with the temperature evaluated in nine concentric locations concurrently. Results The factor with the greatest influence on ice ball size was probe gauge: in all probe types, a change from 18 to 14 increased ice ball width, length, and volume by up to 70%, 113%, and 512% respectively, with minimum internal temperature decreasing as much as from −5 to −32 °C. In contrast, alternating the type of meat (chicken, beef, pork) and the shape of the probe tip (straight, coudé) affected ice ball dimensions to a negligible degree. The ice ball dimensions and the zone of adequate temperature drop were not always correlated, and, even within a visualized ice ball, the temperature was often inadequate to induce Wallerian degeneration. Conclusions Percutaneous probe design can significantly influence the effective cryoneurolysis zone; visualizing a nerve fully encompassed in an ice ball does not guarantee adequate treatment to induce the desired Wallerian degeneration because ice forms at temperatures between 0 and −20 °C, whereas only temperatures below −20 °C induce Wallerian degeneration. The correlation between temperatures in isolated pieces of meat and perfused human tissue remains unknown, and further research to evaluate these findings in situ appears highly warranted.https://doi.org/10.1007/s40122-023-00497-yAnalgesiaPostoperative painChronic painAcute painCryoneurolysisCryoablation |
| spellingShingle | Engy T. Said Brennan P. Marsh-Armstrong Seth J. Fischer Preetham J. Suresh Matthew W. Swisher Andrea M. Trescot J. David Prologo Baharin Abdullah Brian M. Ilfeld Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research Pain and Therapy Analgesia Postoperative pain Chronic pain Acute pain Cryoneurolysis Cryoablation |
| title | Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research |
| title_full | Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research |
| title_fullStr | Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research |
| title_full_unstemmed | Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research |
| title_short | Relative Effects of Various Factors on Ice Ball Formation and Ablation Zone Size During Ultrasound-Guided Percutaneous Cryoneurolysis: A Laboratory Investigation to Inform Clinical Practice and Future Research |
| title_sort | relative effects of various factors on ice ball formation and ablation zone size during ultrasound guided percutaneous cryoneurolysis a laboratory investigation to inform clinical practice and future research |
| topic | Analgesia Postoperative pain Chronic pain Acute pain Cryoneurolysis Cryoablation |
| url | https://doi.org/10.1007/s40122-023-00497-y |
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