The new knee surgeon (he's not new, but new to me) that I am seeing for TKR (South Orange County, CA) only does Iovera before surgery. His associate does the injections. This surgeon has one of the longest waiting lists to get in to, and has the best reviews online. I think anything can damage nerves (I know this because my dogs pulled me so hard while walking them that I now have nerve damage on my index finger, even after repair surgery). The surgeon I had been seeing before (who doesn't do robotic, and I want that) said that Iovera will be the way to go now unless you opt for an 18-24 hour nerve block. I guess my fear of my bone being cut off during a TKR is more frightening than the possible side effects of the longer lasting nerve block...so hoping I don't regret it...but I am so afraid of this surgery that I'll do the Iovera..