Update Course Rewind: Part 2 Non-Pectus Uses of Cryoanalgesia 2024
With Dr. Thomas Inge · hosted by Dr. Lizzie Lee · StayCurrentMD
Part of
Pectus Excavatum 58 items
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What the experts said
Interventional radiology has percutaneous needle options available for cryotherapy beyond the standard cryoprobe.
Cryoablation has shown real benefits for rib fractures, slipping rib syndrome, and other endochondromas.
Laxity in costochondral junctions and impingement on intercostal nerves as the ribs slip and float causes slipping rib syndrome.
Slipping rib syndrome can be the cause of chronic abdominal wall pain.
Patients with slipping rib syndrome may have already had their appendix or gallbladder removed before arriving at the correct diagnosis.
Patients with slipping rib syndrome often undergo multiple colonoscopies, CTs, and ultrasounds before diagnosis.
The usual approach for patients with slipping rib syndrome is to refer them to chronic pain for evaluation and intercostal block with steroid and long-acting local anesthetic.
If there's a response to intercostal block, the next step is to refer to surgery.
Interventional radiology performs cryoablation using needle probes at single or multiple levels for slipping rib syndrome.
Cryoablation can be used intraoperatively in combination with surgery to remove rib tips or stabilize a slipping cartilaginous costal margin.
For patients with chest rib fractures who get stuck on a ventilator, cryoablation can do a world of good by anesthetizing the intercostal spaces that are the problem.
Interventional radiology colleagues use the same needles for cryoablating liver lesions and lung nodules that can be applied to intercostal nerve cryoablation.
Cryoablation is not limited to thoracotomy or thoracoscopy; there are novel ways to use cryotherapy in a percutaneous approach.
Slipping rib syndrome is a condition with cartilaginous union at the end of the ribs, particularly for floating ribs but also for false ribs.
Slipping rib syndrome is more common in teenage girls than boys.
Patients with slipping rib syndrome often present with somatic tenderness of the abdominal wall that can be elicited by asking them to flex or crunch their abdominal muscles, but they really won't have a visceral type tenderness.
If patients get pain relief from the intercostal block with ropivacaine and dexamethasone, the next step is to refer them to interventional radiology for ultrasound-guided cryotherapy.
Outcomes from using cryoablation for slipping rib syndrome included reduced pain scores, reduced narcotic use, and shorter length of stay in the hospital.
Patients treated with cryoablation for slipping rib syndrome were able to resume normal activities much earlier.