Kwater A P, Sen S, de Haan J B, Ge M A, Kim A M, Hernandez N
University of Texas MD Anderson Cancer Center, Department of Anesthesiology & Perioperative Medicine, 1400 Holcombe Blvd., Unit 409, Houston, TX 77030, United States of America.
McGovern School of Medicine at UTHealth, Department of Anesthesiology & Perioperative Medicine, 6431 Fannin Street, MSB 5.020, Houston, TX 77030, United States of America.
Trauma Case Rep. 2023 Jan 3;43:100751. doi: 10.1016/j.tcr.2022.100751. eCollection 2023 Feb.
Establishing adequate analgesia for rib and sternal fractures remains a challenge due to the prolonged nature of the associated pain. Historically, cryoneurolysis has demonstrated beneficial in treating chronic pain, and the recent development of hand-held devices has allowed its functionality to expand into the management of acute pain.
We present a polytrauma patient with sternal and multiple rib fractures that underwent ultrasound-guided intercostal cryoneurolysis at bedside, resulting in significant analgesia lasting several weeks and improving mobilization. This is the first report of the utilization of cryoneurolysis to treat acute sternal fracture pain.
The most common sternal fracture pattern is transverse which only requires treatment of four intercostal nerves, making cryoneurolysis feasible in trauma centers. This portable, minimally invasive, and low risk technique has the added benefits of reducing opioid requirements, decreasing length of hospital stay, and improving mobility in polytrauma patients.
由于肋骨和胸骨骨折相关疼痛持续时间较长，建立充分的镇痛措施仍然是一项挑战。从历史上看，冷冻神经lysis已证明对治疗慢性疼痛有益，而手持设备的最新发展使其功能扩展到急性疼痛的管理。
我们报告一名多发伤患者，伴有胸骨和多根肋骨骨折，在床边接受了超声引导下肋间冷冻神经lysis，结果产生了持续数周的显著镇痛效果，并改善了活动能力。这是关于利用冷冻神经lysis治疗急性胸骨骨折疼痛的首例报告。
最常见的胸骨骨折类型是横向骨折，仅需治疗四根肋间神经，这使得冷冻神经lysis在创伤中心可行。这种便携式、微创且低风险的技术具有减少阿片类药物需求、缩短住院时间以及改善多发伤患者活动能力等额外益处。
