Short communication: ultrasound-guided percutaneous cryoanalgesia of intercostal nerves for uniportal video-assisted thoracic surgery.

IF 3.4 Q2 Medicine Ultrasound Journal Pub Date : 2022-07-30 DOI:10.1186/s13089-022-00284-4
Matías Nicolás, Cecilia M Acosta, Marcelo Martinez Ferro, Agustín Alesandrini, Sofía Sullon, Facundo A Speroni, Gerardo Tusman
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引用次数: 1

Abstract

Background: Pain after thoracic surgery impairs lung function and increases the rate of postoperative pulmonary complications. Ultrasound-guided percutaneous cryoanalgesia of intercostal nerves constitutes a valid option for adequate postoperative analgesia. A key issue for a successful cryoanalgesia is placing the cryoprobe tip close to the intercostal nerve. This report describes an ultrasound technique using a high-resolution ultrasound probe to accomplish this goal.

Findings: Images of five anesthetized patients undergoing uniportal video-thoracoscopic surgeries are used as clinical examples. In the lateral position, a high-frequency 12 MHz probe is placed longitudinally at 5-7 cm parallel to the spine at the 4th, 5th, and 6th ipsilateral intercostal spaces. Ultrasound images detect the intercostal neurovascular bundle and a 14G angiocath is placed beside the nerve. The cryoprobe is inserted throughout the 14G catheter and the cryoanalgesia cycle is performed for 3 min. Two ultrasound signs confirm the right cryoprobe position close to the nerve: one is a color Doppler twinkling artifact that is seen as the quick shift of colors that delineates the cryoprobe contour. The other is a spherical hypoechoic image caused by the ice ball formed at the cryoprobe tip.

Conclusions: Ultrasound images obtained with a high-frequency probe allow precise location of the cryoprobe tip close to the intercostal nerve for cold axonotmesis.

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短沟通:超声引导下经皮肋间神经冷冻镇痛在单门静脉胸外科手术中的应用。
背景:胸外科术后疼痛会损害肺功能,增加术后肺部并发症的发生率。超声引导下经皮肋间神经冷冻镇痛是术后充分镇痛的有效选择。低温镇痛成功的一个关键问题是将低温探针尖端放置在靠近肋间神经的地方。本报告描述了一种使用高分辨率超声探头来实现这一目标的超声技术。结果:以5例接受单门胸腔镜手术的麻醉患者为例。在侧位,高频12 MHz探头纵向放置在与脊柱平行的5-7 cm处,位于第4、第5和第6同侧肋间隙处。超声图像检测肋间神经血管束,在神经旁放置14G血管导管。冷冻探头贯穿14G导管,进行3分钟的冷冻镇痛循环。两个超声标志确认了冷冻探头靠近神经的正确位置:一个是彩色多普勒闪烁伪影,可以看到颜色的快速移动,描绘了冷冻探头的轮廓。另一种是由低温探针尖端形成的冰球引起的球形低回声图像。结论:高频探头获得的超声图像可以精确定位低温探头尖端靠近肋间神经的位置,用于冷轴索术。
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来源期刊
Ultrasound Journal
Ultrasound Journal Health Professions-Radiological and Ultrasound Technology
CiteScore
6.80
自引率
2.90%
发文量
45
审稿时长
22 weeks
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