D.A. Sniatkewicz1, K.M. Klifto1, S. Wiesemann1, J.T. Kaifi1 1University of Missouri-Columbia School of Medicine, Columbia, MO, USA
Introduction: Cryoanalgesia may be applied directly to intercostal nerves as a method of managing postoperative pain following thoracic surgery. Within a targeted cold temperature range, peripheral nerve function may become temporarily interrupted and gradually recover without injury. Due to the relatively small sample sizes published in the literature, the purpose of our study was to determine if intraoperative cryoanalgesia decreased chronic postoperative pain and opioid requirements following thoracic surgery for anatomic lung resection.
Methods: An IRB-approved, retrospective medical record review was performed to include patients >15 years of age who underwent anatomic lung resection via thoracotomy from January 2017 to October 2021. Patients were excluded if they had a diagnosis of chronic pain prior to surgery. All patients had inpatient and outpatient pain medication records (opioids, propofol, ketamine, lidocaine, benzodiazepines, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), muscle relaxers) with pain score assessments, outcomes, and complications at 1-month, 3-months, 6-months, 12-months, and 24-months. Cohorts were stratified by patients who received intercostal nerve targeted cryoanalgesia and patients who did not receive cryoanalgesia. Cohorts were analyzed using univariate analyses for continuous and dichotomous variables based on the statistical distribution of data. All statistical tests were two-tailed, with the threshold for statistical significance set at a α value of 0.05.
Results: Two hundred and eighty-eight patients were included (cryoanalgesia=201; no cryoanalgesia=87). There were no statistically significant differences for age, sex, body mass index, former smoking status, and postoperative complications between the two cohorts. Table 1 includes data comparing whether any pain was reported over 24-months of follow-up clinic visits for cryoanalgesia and no cryoanalgesia cohorts. Compared to no cryoanalgesia, intraoperative intercostal nerve targeted cryoanalgesia was associated with significantly fewer patients with any pain reported at 1-month, 6-months, and 24-months.
Conclusion: Intraoperative intercostal nerve targeted cryoanalgesia is a useful adjunct which may prevent the formation of chronic pain following thoracic surgery for anatomic lung resection.