Chilling the pain: An innovative device helps reduce severe post-surgery pain

NEW ORLEANS, LA (WVUE) - Many locals have an aversion to bone-chilling cold. But doctors at LSU Health in New Orleans are using a procedure that involves a drastic drop in temperature and it results in a dramatic reduction in post-surgery pain. It's an innovation that could help knock the wind out of the deadly opioid addiction crisis.

"So, this is the knee, and what we can see is the knee is basically bone on bone," said Dr. Vinod Dasa, an LSU Health New Orleans orthopaedic surgeon.

Knees are critical to remaining mobile. But if they aren't shown the appropriate respect, the result can be revenge.

"So cartilage is basically what coats the end of the long bones. If you think back to Thanksgiving, you snap open the turkey joint, you see that smooth, white, shiny stuff, imagine if I took a fork and started scraping it away. That's called arthritis," said Dasa.

In October of 2017, Eric Windmann had his right knee replaced. He is a patient of Dr. Dasa.

"So in a knee replacement, what we do is we trim away just the end of the bone, so we make a small cut, in some cases less than a 10 millimeters thick, and basically replace the end of the bone with a cap, a metal and plastic cap that fits on the end of the bone so that way you can move the joint freely again," Dasa stated.

Several years ago, Windmann said he left knee received new parts.

"It was very, very painful as soon as I woke up," he said.

The experience was much better after his recent knee surgery.

"I was in no pain. I literally did not take a pain pill the whole time I was in the hospital. I went home that night, I was able to get on a stationary bike and get the knee moving," said Windmann.

Windmann and Dasa credit a medical procedure that literally fits in one's hand.

"And basically within this device we place a nitrous-oxide cartridge that fits in the top," said the doctor.

It produces an "Antarctica" type treatment.

"Cryo-neurolysis is basically freezing of nerves," Dasa said.

Certainly ice has been used for pain for centuries. But Dr. Dasa said it is the way the Ivoera device does it that is innovative.

"Now cryo-neurolysis is taking that original concept and now actually creating an ice cube, or ice ball under the skin, and when that cold hits the nerve, it shuts the nerve off," Dasa said.

And he said typically it's done a week before surgery.

Some arthritis patients not facing surgery get the procedure, too. As shown in a video shot by LSU Health New Orleans, a physician assistant in Dr. Dasa's office first administers a local anesthetic.

"You might feel some tingling and some numbness, burning. That's just the nerve being frozen," she told the patient.

And the extreme temperatures live up to their name.

"The needles itself within the device puncture the skin, and once those needles are under the skin they turn cold, and that's what creates the ice ball," Dasa said.

When asked about the specific temperature, Dasa said, "Minus 80."

In mere minutes, the procedure was over.

A video from Myoscience, the company that patented the Iovera device, shows an animated journey into the body.

"Once we apply focused cold therapy, conduction is interrupted, all signals stop and Wallerian degeneration begins," the video narrator says.

The isolated nerve therapy involves temperatures that rival winter at the dreadfully cold South Pole.

"It made it extremely tolerable, whereas I would say for the first procedure it was not tolerable, at least not for me, for a period of time," said Windmann.

Knee replacements are common, yet serious surgeries. In 2015, the Centers for Disease Control said the rate of total knee replacement increased for men by 86% and by a whopping 99% for women from 2000 to 2010.

Age increases the odds of needing such a surgery, but young people can damage their knees, as well, often during athletic activities.

Windmann rated the level of pain after his first knee replacement compared to the second knee surgery, which included the frozen nerve procedure.

"I would say that for this knee it was every bit of a 10 for an extended period of time, my opinion of course, and then for this one, to be fair about it, it was probably a three. I literally only took narcotic pain medicine for four days post-surgery," he said.

He said he required more powerful pain drugs after the first knee replacement.

"I would say probably for about two, two and a half months, you know, getting through the rehab process," said Windmann.

These outcomes could hold promise for reducing the amount of opioids prescribed, and impact the nation's opioid epidemic in the process.

"Obviously, in the context of the opioid epidemic, we have to find innovative solutions to deal with the issues," Dasa said.

Dr. Dasa said the research looks promising.

"What we found is, we looked at 50 patients before using the technology and our next 50 patients afterwards, and we looked to see how much narcotics and pain medicine the patients were taking," Dasa said. "And what we found was about a 45 percent reduction in the amount of pain medications patients were taking after a knee replacement compared to a group of patients that never got it."

In 2017, the National Institutes of Health said, cryo-neurolysis resulted in statistically significant decreased knee pain and improved symptoms compared to so-called "sham treatment" and appeared safe and well-tolerated. A sham treatment is analogous to a placebo.

"There's no drug, there's no toxin. There's really no anything that's put in the body. It's just simply the needles become cold," Dasa said.

And Dr. Dasa said there is no danger of frozen nerves remaining in that state.

"Around the knee, we would expect it to start coming back, that nerve to be re-growing somewhere around eight weeks," he said.

Dasa said risks include bruising and swelling, but he said his patients have done very well with the procedure, and he envisions the use of the treatment expanding.

"I think eventually this has the potential to become the standard of care. It's not quite yet, I think we still need a little bit more research to establish that, but what we've established so far and the results to date really put on a nice path to do that," Dr. Dasa said.

"You don't have the pain so that you're able to work it more aggressively," said Windmann.

It is a frigid procedure first used for cosmetic purposes.

"In other countries, in Europe, it's targeted for motor nerves originally to try to get rid of wrinkles in Europe, …but the company took that same concept here in the U.S. and used that technology to target sensory nerves around the body, and that's what it's FDA approved for," said Dr. Dasa.

And Windmann said it definitely helped his recovery, which happened with less pain.

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