Ultrasound-guided Cryoneurolysis in Chronic and Acute Pain Management: A Brief Literature Review

超音波導引冷凍神經鬆解術運用於慢性與急性疼痛處理：精簡文獻回顧

賈琬婷(Wan-Ting Chia) ； 石明煌(Ming-Hwang Shyr)

《疼痛醫學雜誌》 27卷2期 (2017/09) Pp. 81-91

摘要

A cryoneurolysis procedure for pain management involves freezing or cooling tips of needles, called cryoprobes, that are placed in precise locations closed to nerves. The targeted cryoablative therapy temperature was -60°C to -100°C resulting in a reversible injury (take 2-12 weeks to recover fully) to the peripheral sensory nerve providing a long lasting (multiple weeks to months) analgesic effect without damaging surrounding tissue. In the past decade, ultrasound has become a useful and efficient tool for interventional pain management. Cryoneurolysis can be safely applied percutaneously in precise location with ultrasound guidance. Although, in our society, some may not be so familiar with its use, it has been used for decades to treat a substantial number of patients with chronic intractable pain, in order to reduce pain, reduce analgesic dose, recover activity of daily livings, and finally to be discharged from the hospital. More recently, it was also advocated to be used in treating some acute postoperative pain as alternatives. In this brief review, we will discuss and focus on the ideas, working mechanisms, clinical applications in chronic and acute pain patient, contraindications and future implementations of ultrasound-guided cryoneurolysis.

關鍵字

Ultrasound ； Acute pain ； Chronic pain ； Cryoprobe ； Neurolysis

並列摘要

冷凍神經鬆解術（cryoneurolysis）能夠運用於疼痛治療。它的原理是將冷凍探針（cryoprobe）精準放置於靠近神經的附近，經由內置冷凍劑與特殊設計，讓針尖形成-60°C到-100°C冰球，使周邊感覺神經產生可回復性傷害（需要兩到十二週的時間完全復原），達到長期間（數周到數個月）止痛的目的，而不至於傷害週邊的血管等組織。近十年來，已經成功將超音波成功與有效運用於各種疼痛介入治療，經皮超音波導引冷凍神經鬆解術能精準安全的將探針放置於週邊神經目標位置上。我們學會有些臨床醫療工作者並不熟悉這項疼痛治療技術，文獻上已有非常大量慢性頑固性疼痛患者已經接受冷凍神經鬆解術，達到緩解疼痛、降低其他止痛劑用量、改善日常生活、以及降低住院期間等目標。更近一些，文獻也證實冷凍神經鬆解術能用於治療急性手術後疼痛，作為替代方案。在這篇精簡論文回顧文章中，我們將重點放在超音波導引下的冷凍神經鬆解術，聚焦於其觀點、作用原理、臨床使用於及慢性疼痛、禁忌症、以及未來發展與障礙等。

並列關鍵字

超音波 ； 急性疼痛 ； 慢性疼痛 ； 冷凍探針 ； 神經鬆解