body thinks local anesthesia, but cryoanalgesia is a
peripheral nerve block," says Brian M. Ilfeld, MD,
MS, a professor of anesthesiology in residence in
the department of anesthesiology at the University
of California San Diego and a leading voice in apply-
ing cryo to treat surgical pain.
That's important because there's a lot of miscon-
ceptions about what it takes to perform cryo, pri-
marily that the procedure is overly complicated.
"This is patently false," says Dr. Wilton. "The land-
mark-based knee application of cryo is simple to
implement and is relatively easy to master if you are
already ultrasound-proficient."
The latter point should apply to virtually all new
6 • S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H
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anesthesia providers. "Almost all
anesthesiologists coming out of
residency are trained in how to
place ultrasound-guided peripher-
al nerve blocks," says Dr. Ilfeld,
"and almost all local surgery cen-
ters and hospitals have ultrasound
equipment, so we don't have to
fight to get the equipment like we
did 10 years ago."
Even so, comprehensive train-
ing is an absolute must for any of
your anesthesia providers who
perform cryo. "Providers must be
skilled in ultrasound-based nee-
dle placement using a targeted
in-plane approach — the needle
enters the skin at the side of the
probe — to confirm the location
of the probe's tip," says Scott
Rigdon, MPH, DNAP, CRNA,
NSPM-C, a anesthesia profession-
al based in Southwest Montana.
"It's also essential to undergo
some formal coursework and
perform several cryo procedures
with a mentor or in the presence
of a device rep."
Multiple
applications
Cryo is FDA approved for use on
any sensory nerve and has a number of practical
applications that can be put to good use by innova-
tive, forward-thinking facilities. For instance, sur-
geons often encourage patients to lose weight
before joint replacement surgery. But if patients are
suffering from severe joint pain, it's difficult for
them to exercise. In these instances, anesthesia
providers can use cryo about a month before proce-
dures to reduce their pain and help them better pre-
pare for their surgeries.
At Mercy Mt. Shasta, Dr. Wilton uses cryo mul-
tiple times per week to help patients prepare for
surgery, treat chronic pain and reduce the opioid
prescriptions needed following notoriously
NEW CLASS Almost all anesthesiologists coming out of residency are now trained in how to place ultrasound-guided
peripheral nerve blocks.
