Evaluating the Predictive Value of Pre-procedural Diagnostic Nerve Blocks in Patients Undergoing Cryoneurolysis

To evaluate the impact of pre-cryoneurolysis blocks by comparing outcomes between patients who underwent cryoneurolysis without a pretreatment block and those who underwent cryoneurolysis following a diagnostic block.

A retrospective single-center analysis was performed of patients who underwent CT-guided cryoneurolysis for intractable abdominopelvic pain. Patients were categorized according to whether a pre-cryoneurolysis diagnostic block was performed. Clinical success was defined as an improvement in Visual Analog Scale (VAS) pain score of ≥ 3 points. Pre- and post-procedural pain scores and adverse events (AEs) were assessed.

For entire cohort, including 52 patients who received a pre-cryoneurolysis block and 43 patients who did not, mean VAS score improved from 8.4 ± 1.6 pre-procedurally to 3.9 ± 2.5 at 1 week (p < 0.001), 3.8 ± 2.7 at 1 month (p < 0.001), and 4.8 ± 3.2 at 3 months (p < 0.001) after cryoneurolysis. Use of a pre-cryoneurolysis-block was associated with a mean delay of 16.1 ± 13.5 days (range, 0-50) to cryoneurolysis. Clinical success rates did not differ significantly between the block and non-block groups at 1 week (76.6% [36/47] vs 78.4% [29/37], p = 1.0), 1 month (81.1% [30/37] vs 69.7% [23/33], p = 0.403), or 3 months (62.5% [15/24] vs 75.0% [15/20], p = 0.519). No AEs were observed.

CT-guided cryoneurolysis provides significant pain relief for cancer- and non-cancer-related chronic abdominopelvic pain, with comparable pain improvement regardless of whether a pre-cryoneurolysis diagnostic block is performed. When the pain source is clearly identified, direct cryoneurolysis may be a reasonable option.