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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 5  |  Page : 947-948
Effects of cryoanalgesia on post nephrectomy pain in kidney donors


Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

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Date of Web Publication31-Aug-2010
 

How to cite this article:
Ahmadnia H, Molaei M, Golparvar S. Effects of cryoanalgesia on post nephrectomy pain in kidney donors. Saudi J Kidney Dis Transpl 2010;21:947-8

How to cite this URL:
Ahmadnia H, Molaei M, Golparvar S. Effects of cryoanalgesia on post nephrectomy pain in kidney donors. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Aug 17];21:947-8. Available from: http://www.sjkdt.org/text.asp?2010/21/5/947/68899
To the Editor,

Post operative pain is a common complaint in almost all surgical procedures. Procedures like thoracotomy and renal surgery have the most severe pain because of the respiratory move­ments, and may cause athelectasies and pneu­monia where patients avoid deep inspiration and cough.

Various methods such as, IV narcotics, inter­costal nerve block, long acting analgesic during operation and freezing of these nerves, are used. [1],[2]

We didn't find any study regarding cryoanal­gesia in urological surgeries with flank inci­sion. [3],[4],[5],[6],[7],[8],[9],[10],[11]

W conducted a sequential double blind rando­mized trial with assignment of 30 donor neph­rectomies, into two groups: case (receiving cryo­analgesia) and controls. The surgical procedure was similar in all of the cases with left flank incision and removal of the 11 th rib. The 11 th intercostal nerve was preserved and at the end of procedure, before closure of flank, the 11 th intercostal nerve was released as much as po­ssible in the case group and was freezed for 60 second with -50ºC in proximal part (before branching). This was done using cryoanalgesia probe Ca 2001 T.B.T (Danesh medical enginee­ring company). The intercostal nerve was placed in a notch on the tip of probe and an Ice Ball was formed around it, confirming freezing of the nerve.

All of the information regarding personal data such as age, sex and weight of the patients and duration of the procedure as well as the amount of sedative drug were recorded.

The visual analogue scale (VAS) was used to measure severity of pain, with zero for no pain and ten for the most severe pain yet experienced by the patient. VAS was done post operatively at 4,8 and 12 h and on 2nd, 3 rd, and 4th day at 8 am, 2 pm and 8 pm. Intramuscular sedation with morphine was used provided the pain was more than five. Daily morphine demand was also recorded. Probable complications of cryo such as hyperasthesia and hypoasthesia were re­viewed and recorded during hospitalization and at the end of first, second and third month after discharge by telephone using personal state­ments of the patients. Student t test was used to compare the two groups.

The two groups were similar [Table 1] and the amount of analgesia during operation (phentanyl) was the same in both groups (P> 0.05) Severity of the pain using VAS at different times of the post operation day was not statistically different between the groups(P> 0.05) [Figure 1]. Regar­ding sensory complications, there was only one patient in cryo group with hyposthesia on the incision line that resolved within one month.
Table 1 :Age, sex, weight and surgery time of the patients.

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Figure 1 :The amount of analgesic drugs (morphine) post operation.

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Freezing intercostal nerve causes axonal dege­neration by inflammatory process and blocks nerve conduction. The endoneurium is usually preserved provided the freezing time is short (30-60sec) and regeneration of the nerve occurs within one month. [7] This is used to block the pain following thoracotomy. Other studies have shown beneficial effect in term of post opera­tive pain likely due to the multiple nerve root frozen i.e. freezing the nerves above and below the involved nerve. [3],[5],[8] This is not possible since during donor nephrectomy single nerve root is exposed and extending the incision for cryo­analgesia will not be reasonable.

In conclusion, in our study of donor nephrec­tomy patients cryoanalgesia for reducing pain was not superior to usual post operative pain control measures and is not recommended.

 
   References Top

1.Loan WB, Dundee JW. The clinical assessment of pain. Practitioner 1967;198(188):756-68.  Back to cited text no. 1      
2.Lodd KH, Funk JP, Bonacci R. Clinical signi­ficance of reported changes in pain severity. Ann Emerg Med 1996;27(4):458-9.  Back to cited text no. 2      
3.Orr IA, Keenan DJ, Dundee JW. Improved pain relief after thoracotomy: use of cryoprobe and morphine infusion. Br Med J 1981;283(6297): 945-8.  Back to cited text no. 3      
4.Yang MK, Cho CH, Kim YC. The effects of cryoanalgesia combined with thoracic epidural analgesia in patients undergoing thoracotomy. Aneasthesia 2004;59(11):1073-7.  Back to cited text no. 4      
5.Roberts D, Pizzarelli G. Reduction of post-thoracotomy pain by cryoptherapy of inter­costals nerves. Seand J Thorac Cardiovasc Surg1 988;22(2):127-30.  Back to cited text no. 5      
6.Katz J, Nelson W. cryoanalgesia for post-thoracotomy pain. Lancet 1980;1(8167):512-3.  Back to cited text no. 6      
7.Moorjan N, Zhao F. Effects of cryoanalgesia for post - thoracotomy pain and on the structure of intercosal nerves. Eur J Cardiothorac Surg 2001;20(3):502-7.  Back to cited text no. 7      
8.Roxburge JC. Ross BA. Role of cryoanalgesia in the control of pain after thoracotomy. Thorax 1987;42(4):292-5.  Back to cited text no. 8      

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Correspondence Address:
Hassan Ahmadnia
Department of Urology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad
Iran
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PMID: 20814139

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