Abstract

Intercostal nerve cryoablation (IC) offers potential for targeted and durable analgesia for patients with traumatic rib fractures. Our pilot study aimed to investigate thoracoscopic IC's safety, feasibility, and preliminary efficacy for patients undergoing surgical stabilization of rib fractures (SSRF). We hypothesized concurrent SSRF-IC is a safe and feasible procedure without immediate or long-term complications.We retrospectively evaluated patients aged =18 years who underwent SSRF (with or without IC) for acute rib fractures at our Level I trauma center between 1 September 2019 and 30 September 2020. We performed IC under thoracoscopic visualization (-70 °C for 2 minutes per intercostal nerve bundle). Among patients whose only operative procedure during hospitalization was SSRF, we evaluated post-SSRF length of stay, operative times, opioid requirements (oral morphine equivalents) and pain scores (Numerical Rating Scale). Generalized estimating equations compared SSRF and SSRF-IC group outcomes (population mean[robust standard error]). We assessed long-term outcomes of patients who underwent SSRF-IC.Thirty-four patients (144 ribs) underwent SSRF; of these, 20 patients (135 ribs) underwent SSRF-IC. Patients who did and did not undergo concurrent IC had no significant difference demographic, injury, or hospitalization characteristics. Among 20 patients who did not undergo other operations, 12 underwent SSRF-IC. We did not find significant difference between SSRF and SSRF-IC groups' median operative times or post-SSRF length of stay. Compared to SSRF group, SSRF-IC group did not have statistically significant change in pain score (0.2[1.5] lower) or opioid use (43.9[86.1] mg/day greater) between 12-hours before SSRF and last 24 admission hours. Among 17 SSRF-IC patients who followed-up post-discharge (median[range]: 160[9-357] days), one reported mild chest wall paresthesia; no other complications were reported.Pilot study performing 135 intercostal nerve cryoablations on 20 patients suggests IC is safe and feasible for patients undergoing SSRF. Evaluating IC's analgesic efficacy for rib fractures requires further study.Level IV, prognostic and epidemiological study.

View details for DOI 10.1097/TA.0000000000003391

View details for PubMedID 34446656