Department of Anesthesia and Operative Services, Walter Reed Army Medical Center, Washington, DC 20009, USA.
Pain Physician. 2009 Nov-Dec;12(6):997-1000.
Cryotechnology is a modality of renewed interest in pain management. It is safe and effective when used to treat neuropathies of sensory and mixed nerves. Cryoablation, in general, is devoid of the risk of neuroma formation and can provide several weeks to months of adequate pain relief. Traditionally, cryoablation was applied blindly to the target area. The use of ultrasound guidance may improve the efficacy and reduce morbidity. We report a case of a successful cryoablation of the femoral component of the genitofemoral nerve using ultrasound guidance in a patient with chronic inguinal pain. A 47 year-old male (ASA Classification II for obesity, HLD, and OSA, 125kg, 69 in) presented to the Walter Reed Pain Clinic with the complaint of 4/10 VAS left sided groin pain of 3 month duration. The patient was diagnosed with a neuropathy of the femoral component of the left genitofemoral nerve. He received a diagnostic block with local anesthetic and reported immediate pain relief that lasted one week. The patient was counseled on the risks and benefits of cryoablation. The skin was anesthetized with 1% lidocaine and a 14 gauge angiocatheter needle was introduced using an in-plane technique to the target area. A Westco Cryoablation machine (San Diego, California) with a 14 gauge Lloyd Neurostat cryoprobe was then passed via the angiocatheter. The area was treated for two 3-minute intervals while the cryo probe was visualized under ultrasound. Ultrasound is increasingly utilized for both acute and chronic pain procedures. Ultrasound offered several advantages in this case. It allowed a smaller gauge introducer and cryoablation probe to be used since there was better visualization of the target area. Ultrasound helped identify important vascular structures, allowing safe introduction of the introducer and cryoablation probe. The patient remains pain free at 2-month follow-up.
低温技术是疼痛管理中重新受到关注的一种方式。当用于治疗感觉和混合神经的神经病变时，它是安全且有效的。一般来说，冷冻消融术没有形成神经瘤的风险，并且可以提供数周到数月的足够疼痛缓解。传统上，冷冻消融术是盲目应用于目标区域的。使用超声引导可能会提高疗效并降低发病率。我们报告了一例使用超声引导成功治疗慢性腹股沟疼痛患者生殖股神经股成分的冷冻消融术。一位 47 岁男性（ASA 肥胖、高脂血症和阻塞性睡眠呼吸暂停分类 II，体重 125kg，身高 69 英寸）因左腹股沟疼痛 4/10VAS 就诊于沃尔特·里德疼痛诊所，持续 3 个月。患者被诊断为左生殖股神经股成分神经病变。他接受了局部麻醉剂的诊断性阻滞，并报告了立即缓解疼痛，持续了一周。向患者介绍了冷冻消融术的风险和益处。皮肤用 1%利多卡因麻醉，然后采用平面内技术将 14 号auge 血管造影导管针引入目标区域。然后通过血管造影导管针引入 Westco 冷冻消融机（加利福尼亚州圣地亚哥）和 14 号auge Lloyd Neurostat 冷冻探针。在超声下观察到冷冻探针时，对该区域进行两次 3 分钟的治疗。超声在急性和慢性疼痛程序中都越来越多地使用。在这种情况下，超声具有几个优势。它允许使用较小的引导器和冷冻探针，因为可以更好地观察目标区域。超声有助于识别重要的血管结构，从而可以安全地引入引导器和冷冻探针。患者在 2 个月的随访时仍无疼痛。
