The Experiment Study On Intercostal Nerve Functional Recovery And The Application Of Intercostal Nerve Cryoanalgesia In The Individual Treatment Based On Accurate Anatomy

Objective:(1) To study the pathological change and feature of intercostal nerve at a specific freezing temperature (-70?); (2) To clarify the security of the cryoanalgesia.Methods:24 healthy dogs were randomly assigned to 4 groups according to the freezing time diversity. Cryotherapy instrument was produced by Beijing Kooland medical Devices Co. Ltd. The intercostal nerve freezing temperature was set to-70 ?. In the surgery we separated intercostal nerve lateral cutaneous branches along the rib, perform intercostal nerve cryotherapy at different time including 30,60,90,120 and 180 seconds. Collected chilled intercostal nerve branch at the operative day, after the 10th day, the 30th day and the 60th day respectively, then make the pathological examination.Results:We observed under the microscope on operative day that freezing intercostal nerves at 30 and 60 seconds had no obvious change, and at the freezing intercostal nerves time more than 90 seconds showed edema, necrosis and inflammation reaction. After the 10th day, intercostal nerves at the freezing time more than 60 seconds presented a little edema and inflammation reaction, and the freezing nerves at 120 and 180 seconds presented more necrosis. After the 30th day, nerves at the freezing time less than 90 seconds presented hyperplasia changes, and the freezing nerves at 180 seconds had no obvious hyperplasia changes. After the 60th day, the basic pathological changes of nerves at no more than 90 seconds tended to be normal, and the freezing nerves at 120 and 180 seconds still had hyperplasia changes.Conclusions:(1)The longer the freezing time, the greater the injury of intercostal nerve. (2)The function of nerves can recover after being frozen, the longer freezing time is, the slower function recovery it is. (3)In order to get a satisfactory result of relieving pain clinically, we should better choose the freezing time at more than 90 seconds.(4)At-70?,the freezing nerves at 90 seconds can repair after 60 days, which is safe and reliable.Objective:(1)to investigate the analgesia results and clinical effectiveness on patients of intercostal nerve cryoanalgesia. (2)according to the clinical effectiveness of intercostal nerve cryoanalgesia with thoracoscopic surgery based on the accurate anatomy, to find the best mode for treatment of postoperative pain chest.Methods:60 patients requiring thoracic surgery were randomly assigned to 2 groups(n=30):?cryoanalgesia group;?PCIA group. In the cryoanalgesia group, the intercostal nerves were frozen prior to chest closure for 90 seconds at-70 ? respectively. Intercostal nerves were not frozen in the PCIA group patients. Pethidine was used to alleviate postoperative pain in patients from both groups. Following surgery, the degree of postoperative pain in all patients were assessed by visual analogue scale, postoperative complications were also recorded.Results:The VAS scores of the PCIA group was higher than the cryoanalgesia group. The dosage of pethidine in PCIA group was significantly higher than cryoanalgesia group, both group had no serious cardiopulmonary complications, but PCIA group had more adverse reactions such as nausea, pruritus and vomiting.Conclusion:(1)Intercostal nerve cryoanalgesia is a safe and long-term effective method for relieving post-thoracotomy pain. (2)Precision intercostal nerve cryoanalgesia with thoracoscopic surgery can effectively relieve the postoperative pain in patients, and it is a secure and effective way for postoperative analgesia.