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Cryoanalgesia or
cryoneurolysis is a technique that produces prolonged analgesia by applying cold to
peripheral nerves. The analgesic effects of cold or freezing have been historically
documented as far back as Hippocrates (460-377 BCE). The earliest written records reveal
the use of ice as cold packs applied to tissue prior to surgery. Medieval physicians such
as Avicenna of Persia (982-1070 AD) and Severino of Naples (1580-1656) also used cold as a
means of freezing tissue prior to surgery. Even during wartime in 1812, Napoleon's surgeon
general (Baron Dominique Jean Larre) recognized that limbs of soldiers frozen in ice and
snow could be amputated without significant pain. In 1851, Dr. James Arnett noted that a
mixture of ice and salt at -20°C could produce hemostatic and anesthetic effects
on tumors.1 The modern era of cryoneurolysis began with the development of effective and
controllable cold delivery systems. In 1962, Dr. Irvine Cooper developed a cryotherapy
unit in which liquid nitrogen was circulated through hollow cryoprobes that were thermally
insulated except at the tip. Cryoprobe tip temperature could achieve a nadir of -190°C. At
about the same time, Dr. S. Amoils developed a simple hand-held instrument in which highly
pressurized gas (carbon dioxide or nitrous oxide) could be used to achieve tip
temperatures of -70°C. These devices were the prototypes for the
current generation of cryo probes. |