Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jun 30;39(2):167-171.
doi: 10.1055/s-0042-1745763. eCollection 2022 Apr.

Intercostal Cryoneurolysis

Junjian Huang  1 , Kevin Delijani  2 , Husamuddin El Khudari  1 , Andrew J Gunn  1
Affiliations
Review

Intercostal Cryoneurolysis

Junjian Huang et al. Semin Intervent Radiol. .

Abstract

Chest wall pain affects many patients following chest surgery, fractures, or malignancies, and can be very difficult to manage with normal pharmacologic agents. Intercostal ablation provides one alternative treatment modality for patients suffering from intercostal pain. Intercostal cryoneurolysis involves using extreme cold to cause Wallerian degeneration of the targeted intercostal nerve. This article reviews the patient selection, technique, and complications in the utilization of intercostal neurolysis in the treatment of intractable chest pain.

Keywords: intercostal cryoneurolysis; interventional radiology; nerve ablation; pain management.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Drawing of intercostal nerve anatomy.
Fig. 2
Fig. 2
Ultrasound-guided intercostal nerve block. A 25-gauge spinal needle (white arrow) is inserted with caudal to cranial angulation and then advanced into the subcostal groove. The asterisk (*) denotes the region of the intercostal nerve.
Fig. 3
Fig. 3
Fluoroscopic image with contrast injection into the subcostal groove with subcostal spread of contrast (black arrow). White arrow—needle.
Fig. 4
Fig. 4
Intraoperative axial computed tomographic image of probe placement. Note that the IceSphere 1.5 probe (arrow) is inserted in plane with the affected rib with ablation zone ∼5 mm away from the subcostal groove and 5 cm away from the thoracic nerve roots. Multiplanar reconstruction of the CT demonstrates multiple probe positions.
See this image and copyright information in PMC

References

    1. Karmakar M K, Ho A M. Postthoracotomy pain syndrome. Thorac Surg Clin. 2004;14(03):345–352. - PubMed
    1. Saberski L R. 2007. Cryoneurolysis; pp. 1460–1474.
    1. Cha P I, Min J G, Patil A, Choi J, Kothary N N, Forrester J D. Efficacy of intercostal cryoneurolysis as an analgesic adjunct for chest wall pain after surgery or trauma: systematic review. Trauma Surg Acute Care Open. 2021;6(01):e000690. - PMC - PubMed
    1. Dekonenko C, Dorman R M, Duran Y. Postoperative pain control modalities for pectus excavatum repair: a prospective observational study of cryoablation compared to results of a randomized trial of epidural vs patient-controlled analgesia. J Pediatr Surg. 2020;55(08):1444–1447. - PubMed
    1. Yang M K, Cho C H, Kim Y C. The effects of cryoanalgesia combined with thoracic epidural analgesia in patients undergoing thoracotomy. Anaesthesia. 2004;59(11):1073–1077. - PubMed