Cryoablation on peripheral nerves
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Hi everyone, is there a specific time to defrost in between freezes? Does this time differ based on the patient or location? I have heard as little as 15 seconds and up to 45.
Also, any advice on probe size? I obviously want to use the smallest Cryo probe possible, but I still want to achieve a large ice ball. Can you suggest a probe size that I can use to accomplish both of these? I’m really hesitant to use the 14g probes.
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There is no science yet behind how long you wait between cycles; I wait 30 seconds, because (under US) that is when the ice ball starts to get smaller, and, when I demonstrate the ice ball in water, that is when it starts to get smaller. You actually do want the largest probe possible. I routinely use the 12 and 14g probes in my office without sedation. Slow, gentle advancement of the introducer is key, with tiny doses of local as needed until you are close to the nerve. If you use a standard introducer, there will be about 30 seconds of burning when you first start to freeze the nerve, though that does not happen if you use the new side port introducer that Epimed designed for me. Remember that we use a 13g introducer for PNS in the office without difficulty and without sedation.
Andrea Trescot MD
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Why do we think cryoablation (say of a mixed motor/sensory nerve like the suprascapular nerve) preserves motor function (compared to other neurolytic options)?
When do you choose a neurolytic or cryoablation over PNS when targeting a peripheral nerve?
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Thank you Dr. Trescot,
I never thought of the direct correlation between defrost time and how long it takes for the ice ball to begin melting. You mentioned 30s of pain with the first freeze. Can I not inject a small amount of lidocaine through the introducer before the freeze…as I do with RFAs?
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