Open AccessUltrasound-Guided Cryoablation of Genitofemoral Nerve for Chronic Inguinal Pain
Author(s) -
Napolean A Campos,
John H. Chiles,
Anthony Plunkett
Publication year - 2009
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2009/12/997
Subject(s) - medicine , cryoablation , groin , nerve block , ultrasound , lidocaine , chronic pain , surgery , local anesthetic , anesthesia , radiology , physical therapy , ablation
Background: Cryotechnology is a modality of renewed interest in pain management. It is safeand effective when used to treat neuropathies of sensory and mixed nerves. Cryoablation, ingeneral, is devoid of the risk of neuroma formation and can provide several weeks to months ofadequate pain relief. Traditionally, cryoablation was applied blindly to the target area. The useof ultrasound guidance may improve the efficacy and reduce morbidity. We report a case of asuccessful cryoablation of the femoral component of the genitofemoral nerve using ultrasoundguidance in a patient with chronic inguinal pain.A 47 year-old male (ASA Classification II for obesity, HLD, and OSA, 125kg, 69 in) presentedto the Walter Reed Pain Clinic with the complaint of 4/10 VAS left sided groin pain of 3 monthduration. The patient was diagnosed with a neuropathy of the femoral component of theleft genitofemoral nerve. He received a diagnostic block with local anesthetic and reportedimmediate pain relief that lasted one week. The patient was counseled on the risks and benefitsof cryoablation. The skin was anesthetized with 1% lidocaine and a 14 gauge angiocatheterneedle was introduced using an in-plane technique to the target area. A Westco Cryoablationmachine (San Diego, California) with a 14 gauge Lloyd Neurostat cryoprobe was then passedvia the angiocatheter. The area was treated for two 3-minute intervals while the cryo probe wasvisualized under ultrasound.Ultrasound is increasingly utilized for both acute and chronic pain procedures. Ultrasound offeredseveral advantages in this case. It allowed a smaller gauge introducer and cryoablation probeto be used since there was better visualization of the target area. Ultrasound helped identifyimportant vascular structures, allowing safe introduction of the introducer and cryoablationprobe. The patient remains pain free at 2-month follow-up.Key words: Chronic pain, ultrasound, cryoablation, pain management, neuropathic pain,nerve block